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.  Diffi- cult   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   treat- ment.  Advise  the of   fluids,   and   a symptomatically. Epistaxis patient  to  get-rest,  plenty well-balanced   diet.   Treat 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,  infec- tion,  and  drying  of  the  nasal  mucosa. TREATMENT—An  adequate  physical  examin- ation  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   sym- pathomimetic   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