PHYSICAL DIAGNOSIS OF THE LARYNX 117 



mal; the observer must act quickly and have a thorough understanding of 

 the region and any pathological symptoms noted. 



Percussion of the nose and frontal sinuse is made with some light 

 metal hammer such as the handle end of a key, percussing first one nasal 

 bone and over the frontal sinuses, then the other, to note the difference in 

 sound. A dull sound may indicate a catarrhal condition of the nostril, or 



Fig. 54. — Position of the frontal sinuses a, inferior; b, superior. 



frontal sinuses, the presence of a tumor, or some pathological alterations; 

 on the other hand, the presence of a clear percussing sound should not be 

 taken as indicating that these changes are not present. Large tumors by 

 pressure cause changes or elevations on the nasal bones of the frontal 

 sinuses; such alterations may also be seen in the hard palate see (Fig. 54). 



Physical Diagnosis of the Larynx and Windpipe. 



The symptoms include the bark, cough, and respiration, as well as the 

 local symptoms. The bark is always rough, hoarse, or shrill in all affec- 

 tions of the internal larynx, and is always of great importance in rabies 

 (barking howl), or total loss of voice; this is particularly seen during or 

 after dog shows. The cough is an accompaniment of all affections of the 



