Manual of diseases of the ear : including those of the nose and throat in relation to the ear : for the use of students and practitioners of medicine / by Thomas Barr and J. Stoddart Barr.
- Barr, Thomas, 1846-1916
- Date:
- 1909
Licence: In copyright
Credit: Manual of diseases of the ear : including those of the nose and throat in relation to the ear : for the use of students and practitioners of medicine / by Thomas Barr and J. Stoddart Barr. Source: Wellcome Collection.
Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.
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![1-] surrounding parts. On each side of the septum are the posterior nares or choanae, and projecting inwards from their outer walls are seen the posterior ends of the three turbinal bodies. The middle one of these is generally the most prominent, and appears as an oblong protuberance of a grey or bluish colour. The superior turbinated body is often invisible, and the inferior is generally only seen in its upper part, the rest being concealed by the soft palate. If the mirror be now inclined somewhat laterally, the pharyngeal mouth of the Eustachian tube comes into view, triangular in shape, with its base directed forwards and its apex backwards, situated behind the inferior turbinal on a slightly higher level. Bounding the Eustachian orifice above and behind is a rounded swelling, which varies in prominence in different persons ; and behind that again, and between it and the back wall of the naso- pharynx, is a depression called the fossa of Rosen mailer. On altering the inclination of the mirror, so that the reflecting surface is directed upwards, the roof and part of the back wall of the naso-pharynx can be inspected. Pathological Appearances in the Naso-Pharynx. The most common patho- logical change is met with in children, although occurring also in adults, namely, hypertrophied adenoid or lymphoid tissue, the so-called adenoid vegetations. These are the result of hyperplasia of a normal layer of adenoid tissue present in the mucous membrane of the back wall and roof of the naso-pharynx, the pharyngeal tonsil. Their appearance varies from a slight fringe to a large cor- rugated mass, with vertical rugae, filling the summit of the pharynx and obstructing the view of the upper segment of the septum. In some there is a simple cushion faintly fissured in the middle line. Occasionally the fossae of Rosenmfiller are occupied with these growths. Associated with adenoid growths there may be hyperplasia of the lymphoid tissue in the lip surrounding the Eustachian orifice, giving rise to considerable enlargement of this structure. We may also find swelling or congestion of the mucous membrane, which may be studded with granular projections similar to those observed in the back wall of the pharynx in granular pharyngitis. The posterior ends of the tur- binated bodies, especially the inferior, are frequently seen to be swollen or hypertrophied, and polypi may project through the posterior nares ; sometimes a fibrous polypus is seen completely blocking the naso-pharynx. Mucous or purulent secretion may be seen in greater or less quantity, and thin streaks of pus may be observed over the posterior end of the inferior turbinal ; the presence of pus in the region of the posterior end of the middle turbinal should be noted and its origin investigated. Ulcerations (tubercular or gum- matous), cicatrices, and adhesions are less common. Digital Examination of the Naso-Pharynx. This method is chiefly used in young children where posterior rhinoscopy is impracti- cable. It is of great value, more especially in the diagnosis of adenoids, as by this means a better idea of their amount is obtained than by the use of the reflecting mirror. The little patient is seated upon a chair with the head thrown back resting upon the left arm and body of the examiner, who is standing behind. It is advisable to have an assistant to hold the patient’s hands and secure the legs. The index finger of the right hand, which has been thoroughly washed, is passed into the mouth as far as the c](https://iiif.wellcomecollection.org/image/b24932577_0077.jp2/full/800%2C/0/default.jpg)
