No special after-treatment is required. The patient should be ordered a tepid alkaline nose lotion, and should be encouraged to make use of the nasal air-way and acquire the habit of blowing the nose.
REMOVAL OF FOREIGN BODIES FROM THE NOSE
It might be helpful to remember that foreign bodies not only enter the nasal cavities (1) through the anterior nares, but also (2) through the posterior choanæ, or (3) by penetration through the walls. They may also arise (4) in situ, as in the case of sequestra and rhinoliths. The last group will be considered separately.
A foreign body, if small, may form the centre of a rhinolith.
Operation. Great care and gentleness are required in the removal of foreign bodies from the nose. The extraction should never be attempted blindly, or forcibly, or hurriedly. A little delay to make necessary arrangements does no harm. If a child will not submit to examination it is much better to employ a general anæsthetic so as to complete examination and, if found necessary, extraction at the one sitting. If the nose be not well illuminated and opened with a nasal speculum, groping about in the dark will only do further damage and result in disappointment.
Fig. 288. Nasal Dressing Forceps.
In adults removal can generally be carried on under cocaine. The nostril is cleaned with cotton-wool, and if the extremity of the probe used for detecting the presence of a foreign body be curved to a right angle, it will also serve for gently levering or displacing it forwards. With a small pair of nasal dressing forceps (Fig. 288) it can generally be firmly seized and gently extracted, care being taken not to include any of the mucosa nor to drag the foreign body out regardless of the sinuosities of the cavity. Lister’s ear hook is a most useful instrument. Sometimes a nasal snare will help to extract the substance or to tilt or drag it into a better position.
Unless coated with solid accretions there is never any need to break up a foreign body; anything small enough to slip into the nose is small enough to be extracted entire. If it should be found impossible to remove the body through the anterior nares, it may be pushed backwards into the post-nasal space, where the forefinger of the left hand is in readiness to prevent its falling into the gullet or larynx.
The usual warm alkaline lotion may be used to clear the nose, but liquid should never be forcibly injected into the nostril with the idea of thus expelling the foreign body. If the lotion be sent up the nasal chamber on the same side it will only drive the intruding substance further in; if injected on the opposite side there is risk of otitis media.