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This should be excluded radiologically before excision or biopsy. 3 Percentage prevalence of nasal polyps Normal population (b) Fig. 15 (a) Bilateral nasal polyps presenting in the nasal vestibules. A polyp can easily be confused with Fig. 16 Antrochoanal polyp. A surgical specimen showing the classic dumbbell appearance. This caused total unilateral nasal blockage. Young children (and on occasion, psychiatric cases) are the main patients who insert foreign bodies into the nose. The variety of foreign bodies is protean (Fig.
Occasionally animal foreign bodies such as fleas, ants or flies may enter the external ear canal, causing distressing tinnitus. The creature is killed by instillation of either alcohol or spirit and then may be syringed or suctioned out. Very rarely the foreign body may be located in the middle ear. This will require a formal opening into the middle ear (tympanotomy) for extraction. Suction is satisfactory for the majority of foreign bodies Fig. 62 Instruments used in the removal of aural foreign bodies.
The ear canal must be kept meticulously clean and dry. Clotrimazole, econazole and nystatin can be applied topically as drops, cream or powder. These should be used for at least 3–4 weeks to ensure that all fungal spores have germinated and are destroyed. Instillation of aural drops The maximum benefit of aural drops can only be gained if they are correctly instilled (Fig. 64). If possible, any canal debris should be cleaned before their use; this is particularly important in cases of otitis externa.