CHAPTER XXIV. 



DIAGNOSIS OF INFECTIONS OF THE NASAL AND AURAL 



CAVITIES. 



IN taking material from the nasal cavities, for bacteriological 

 examination, it is well to wash about the alae with sterile water and 

 then have the patient blow his nose on a piece of sterile gauze and take 

 the material for culture or smear from this. If the material is purulent 

 and located at some ulcerating spot, it is best to use a speculum, and 

 either touch the spot with a sterile swab or use a capillary bulb pipette 

 with a slight bend at the end. 



Normally, we find only white staphylococcus colonies and colonies of short-chain 

 streptococci. The M. tetragenus, B. xerosis, and Hoffman's bacillus are also 

 occasionally found. 



In some cases of ozena we may find an organism of the Friedlander type in pure 

 culture. 



Biscuit-shaped diplococci, both Gram negative and positive, are to be found 

 either normally or in cases of coryza. M. catarrhalis has probably been frequently 

 reported as the meningococcus. Still, the meningococcus has been found in the 

 nasal secretions of patients with cerebrospinal meningitis. B. influenzas and the 

 pneumococcus have also been frequently found in cultures from the nasal secretions. 



Diphtheria involving the nasal cavity must always be kept in mind, and in 

 quarantine investigations the examination of the nasal secretions culturally should 

 be a part of the routine. 



The tubercle bacillus may be found in nasal ulcerations; it is, however, only 

 present in exceedingly small numbers. On the other hand, one of the best diagnostic 

 procedures in leprosy is to examine smears from nasal mucous membrane for the 

 B. leprae. In such ulcerations the bacilli are found in the greatest profusion. Rarely 

 glanders may cause ulcerations. 



B. proteus is frequently responsible for the production of foul odors in nasal 

 discharges but does not seem to produce inflammatory conditions of the nasal 

 mucosa. It simply decomposes the discharges. Various fungi have been reported 

 from the nose, but in such a region the strictest conservatism in reporting should be 

 observed. 



Recently sporozoa have been reported in a case of nasal polyp. (Rhinosporidium.) 



So many degenerative changes in epithelial cells resemble protozoal forms that 

 such findings require ample confirmation. 



The larval form of Linguatula rhinaria is a rare parasite of the nasal cavities; 

 it is not infrequent, however, in the nostrils of dogs. 



328 



