Malformations of varying degrees of severity, from complete absence to slight cleft lip, may exist. There may be no external abnormality, but the floor of the nasal cavity may be lacking, the septum deviated, or there may be complete obstruction to one or both nostrils by bony growths.

Rhinitis or coryza is an inflammatory condition of the mucous membrane of the nose. It may be acute or chronic and may be caused by direct or indirect influences.

The acute form is generally attributed to cold, but may be brought about by exposure to the inhalation of various irritating bodies, as pollen of flowers or the fumes of various chemicals, by the action of micro-organisms, or by vasomotor disturbances.

There is first a condition of hyperemia and dryness of the nasal mucosa, which is soon followed by a discharge that is serous, seromucous, or mucopurulent in character. This may cause excoriation of the tissues that it comes in contact with. In the discharge are found epithelial cells and leukocytes as well as bacteria.

Chronic rhinitis usually follows repeated attacks of the acute form, but may be due to some abnormality of the nose itself. It may be of two forms, the hypertrophic and the atrophic.

In the hypertrophic variety there is congestion of the veins with thickening and swelling of the mucosa. The mucous glands increase in size, there is a thick, viscid secretion, and the nasal passages are much obstructed, particularly by enlargement of the lower turbinated bones. There is also a hyperplasia of the connective tissue.

The atrophic form may follow in the course of the hypertrophic. The hyperplastic fibrous tissue shrinks, the epithelium of the mucosa and the glands are destroyed, and there is a secretion of a yellowish purulent matter. This latter has an extremely disagreeable odor; the condition is termed ozena. The bony septum may even be destroyed. In the discharge saprophytic organisms as well as others may be found.

Diphtheria may involve the nasal mucosa primarily, but usually is secondary to the pharyngeal form. In it there is a pseudo-membrane formed and the organism of diphtheria can be found.

Syphilis generally occurs in the form of a coryza that does not differ from that arising from other causes. In the later stages ulceration with necrosis of the bones may occur. Gumma situated within the periosteum or perichondrium may form. This is often followed by destruction with the sinking in of the bridge of the nose.

Tuberculosis may give rise to ulceration with subsequent necrosis. In the discharges the tubercle bacilli can be demonstrated.

Leprosy is said to be first demonstrable in discharges coming from ulcerations of the nose.

Glanders may be conveyed from a diseased horse to the nasal mucosa of man and give rise to nodules or farcy buds.

Tumors

The most common form is that known as a polyp. Polyps are composed of fibrous tissue, that is generally myxomatous, and a covering of mucous membrane. These growths may be mucous, adenomatous, cystic, or telangiectatic.

Various forms of connective-tissue tumors, as the fibroma, chondroma, osteoma, and sarcoma, occur. The fibroma may give rise to severe hemorrhage if it is highly vascular. The sarcoma is the most common malignant tumor. It may arise from the septum, but more frequently it extends from the antrum.

Carcinoma is not so common, but epitheliomata may develop at the junction of the skin and mucous membrane.

Chondritis and perichondritis are inflammations of the cartilages of the larynx secondary to ulcerations of adjoining tissues. The cartilages, being very poorly supplied with blood, have their nutrition interfered with by the inflammatory conditions and degenerative changes ensue. In old age the cartilages may undergo calcification.