TREATMENT—Transfer the patient to a medical facility for definitive treatment as soon as possible. Treat symptomatically until you make the transfer.
Tinnitus
Tinnitus is a noise or “ringing” in the ears that, although bearable during the day, is more distrubing at night. The cause may be infection, toxic doses of medications, or vascular and/or vasomotor disease.
TREATMENT—Reassure the patient. Difficult or severe cases should be referred to a medical facility for treatment of the underlying cause.
Foreign Bodies
Foreign bodies in the ear are normally inanimate objects, such as erasers, buttons, peas and beans. These are normally introduced by the patient in an attempt to scratch the ear or to remove cerumen or by children. Animate objects, such as ticks and moths, may crawl into the ear canal.
SYMPTOMS—There is usually pain, fullness, loss of hearing, and visualization of the foreign body.
TREATMENT—The nature of the foreign body must first be determined. If the object is animate, hold a bright light to the ear. Since insects are attracted to light, this may induce the insect to crawl out. If this fails, instill a few drops of alcohol into the ear to kill the insect, and irrigate to remove it. For hydroscopic bodies such as peas and beans, DO NOT use water, saline, or boric acid, as these liquids will cause the object to swell and become wedged in the ear canal. Use a fine wire ear curette or irrigate with alcohol or light oil to remove the object. If the object is sharp or pointed, be very careful to prevent further injury. If necessary, transfer the patient to a medical facility for removal.
Conditions of the Nose
Common Respiratory Disease
The common cold is the best example of this type of ailment.
SYMPTOMS—They include malaise, little or no fever, headache, chills, nasal discharge, red nares, and sneezing.
TREATMENT—There is no specific treatment. Advise the patient to get-rest, plenty of fluids, and a well-balanced diet. Treat symptomatically.
Epistaxis
The most common sites of nasal bleeding are the mucosal vessels located over the cartilaginous nasal septum and the anterior tip of the inferior turbinate. The cause is normally trauma, infection, and drying of the nasal mucosa.
TREATMENT—An adequate physical examination to determine the scope and location of bleeding is essential. Applying pressure over the nose (pinching) will stop most bleeding. A small pledget of cotton moistened with hydrogen peroxide, phenylephrine, or epinephrine may be effective in stopping the bleeding. Severe posterior epistaxis may require a nasal pack.
Allergic Rhinitis
This is a reaction caused by sensitization to an allergen, which is usually pollen.
SYMPTOMS—It is characterized by nasal congestion, a watery discharge, itching of the nasal mucosa and conjunctival, and violent sneezing.
TREATMENT—Antihistamines and sympathomimetic drugs, such as ephedrine, may be indicated. Steroids are sometimes effective. Have the patient avoid specific allergens, if possible.
Conditions of the Pharynx
Acute Tonsillitis
This is a bacterial infection of the tonsils that may be either foodborne or airborne.
SYMPTOMS—It is characterized by sudden onset of anorexia; malaise; fever; sore throat; red, swollen tonsils; presence of pustules on the tonsils; difficulty in swallowing; and swelling and tenderness in the cervical lymph nodes. 2-20