|Year : 2019 | Volume
| Issue : 4 | Page : 206-208
Rhinolith: A case report
Rakesh Kumar1, Jagadish Kumar A Sunkum1, Ankur Khanna1, Gurjeet Singh2
1 Department of ENT, N. C. Medical College and Hospital, Israna, Panipat, Haryana, India
2 Department of Microbiology, N. C. Medical College and Hospital, Israna, Panipat, Haryana, India
|Date of Submission||20-Mar-2020|
|Date of Acceptance||23-Mar-2020|
|Date of Web Publication||29-Apr-2020|
Dr. Rakesh Kumar
Department of ENT, N. C. Medical College and Hospital, Israna, Panipat 132107, Haryana.
Source of Support: None, Conflict of Interest: None
A case of large rhinolith arising on a foreign body is presented. Rhinolith is synonymous with the stone in the nose. It may be asymptomatic in some patients. A 30-year-old female patient presented with nasal obstruction, intermittent foul-smelling nasal discharge, and bleeding from the right nasal cavity. The patient was diagnosed as a case of rhinolith by endoscopy, X-ray para nasal sinuses (PNS) and confirmed by computerized tomography scan of PNS. She was operated successfully and rhinolith was removed.
Keywords: Foul-smelling nasal discharge, nasal obstruction, rhinolith, rhinosinusitis
|How to cite this article:|
Kumar R, Sunkum JA, Khanna A, Singh G. Rhinolith: A case report. MGM J Med Sci 2019;6:206-8
| Introduction|| |
Rhinolith is a mass formed due to calcification of an endogenous or exogenous nidus inside the nasal cavity. It typically happens secondary to a foreign body in the nasal cavity. The cause of rhinolith could be exogenous (e.g., grains, small stone fragments, plastic parts, seeds, insects, glass, wood and others) or endogenous, resulting from dry discharge, clumps, cell products, necrotic mucosa, and tooth fragments. There have been reports of monster rhinolith caused by nasal aspergillosis. Foreign bodies of high radiodensity may be diagnosed by routine radiography. However, computed tomography (CT) might be useful in the diagnosis of objects of lower radiodensity and help in formulating operative approach. We present a case of large rhinolith, arising on a foreign body.
| Case report|| |
A 30-year-old female patient presented with complaints of foul-smelling recurrent rhinorrhoea for 5 years. The patient also complained of bleeding from the right nasal cavity, intermittent headache, and nasal obstruction of the right side nasal obstruction. Nasal endoscopy was performed [Figure 1], which showed a mass on the floor of the nose with secretions in the right nasal cavity. CT PNS (CT scan of paranasal sinuses) [Figure 2] confirmed the rhinolith on the floor of the nose in the nasal cavity extending below the inferior turbinate. Consent was taken. Extraction was carried out using the hybrid technique (endoscopy and traditional method using headlight). The extracted rhinolith was sent for biopsy. The biopsy report revealed that the mass consisted of a pearl [see [Figure 3]] on which concrete material was deposited.
|Figure 1: (A) The rhinolith as seen with 0° nasendoscope. (B) Nasal endoscopy findings|
Click here to view
|Figure 2: (A) Computed tomography (CT) scan of paranasal sinuses (PNS) axial view. (B) CT scan of PNS coronal view|
Click here to view
| Discussion|| |
Rhinoliths are uncommon; they occur by deposition of salts on an intranasal foreign body and other endogenous substances. There is an impaction of the foreign body in the nasal cavity, which causes chronic inflammation, obstruction and stagnation of nasal secretions. The incidence of rhinolith is about 1 in every 10,000 ENT outpatients. Its literal meaning is “stone of the nose.”, Sometimes the rhinolith is created inside the nasal cavity by continuous, slow, layer-by-layer deposition of calcium and magnesium salts present in the nasal secretions over a nidus.
The nidus might be endogenous or exogenous. Endogenous means the stone created on a nidus inside the body. Exogenous nidus is always a foreign body such as a piece of paper, seed, plastic etc brought into the nasal cavity. This is typically found in little kids or in mentally challenged individuals. The manifestations are slow and insidious. The nasal discharge could be one-sided, foul-smelling, or bloodstained. Rarely, they may cause palatal perforation. The diagnosis of a foreign body nose can be made with this history alone. However, at times patients are misdiagnosed and treated on the lines of rhinosinusitis. At times the patients may have no nasal signs or symptoms but have halitosis.
Nowadays, the fiber-optic nasal endoscopes can make the diagnosis extremely clear. Plain X-ray of PNS, as a rule, confirms the diagnosis in some cases. However, in some cases, CT scan must be performed to confirm the diagnosis., In our case too, the rhinolith was not clearly seen on plain radiography. The diagnosis was confirmed by the CT scan. A rhinolith is normally of irregular shape, yet some times it becomes very large and its size and shape give an appearance of a staghorn calculus of renal pelvis.
| Conclusion|| |
Rhinolithiasis is an uncommon disease that might be left undiscovered for a long time. It should be considered in patients with unilateral nasal block, foul-smelling nasal discharge and intermittent nasal bleeding. The diagnosis is confirmed by plain X-ray PNS or CT scan PNS. The rhinolith may be removed by endoscopy or by lateral rhinotomy as in the case of big rhinolith.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Vedasalam S, Sipaul F, Hill A, Porter G. Nasendoscopy for unusual nasal symptoms.BMJ Case Rep 2010;2010:1-3.
Aziz Y, Chauhan J, Hasan SA, Hashmi SF. Staghorn rhinolith in nasopharynx: An unusual case. Indian J Otolaryngol Head Neck Surg 2008;60:91-3.
Singh AK, Gujar M, Shiral S, Raizada RM. Rhinolith: An unusual presentation. Indian J Otolaryngol Head Neck Surg 2004;56:297-8.
Shah FA, George S, Reghunanden N. A case presentation of a large rhinolith. Oman Med J 2010;25:230-1.
Chatziavramidis A, Kondylidou-Sidira A, Stefanidis A, Soldatou S. Longstanding rhinolith leading to anatomical alterations of the ipsilateral inferior nasal meatus and turbinate. BMJ Case Rep 2010;2010:1-4.
[Figure 1], [Figure 2], [Figure 3]