• Users Online: 137
  • Print this page
  • Email this page


 
 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 6  |  Issue : 4  |  Page : 206-208

Rhinolith: A case report


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 Submission20-Mar-2020
Date of Acceptance23-Mar-2020
Date of Web Publication29-Apr-2020

Correspondence Address:
Dr. Rakesh Kumar
Department of ENT, N. C. Medical College and Hospital, Israna, Panipat 132107, Haryana.
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_23_20

Rights and Permissions
  Abstract 

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

How to cite this URL:
Kumar R, Sunkum JA, Khanna A, Singh G. Rhinolith: A case report. MGM J Med Sci [serial online] 2019 [cited 2020 Oct 30];6:206-8. Available from: http://www.mgmjms.com/text.asp?2019/6/4/206/283466




  Introduction Top


Rhinolith is a mass formed due to calcification of an endogenous or exogenous nidus inside the nasal cavity.[1] 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.[1] 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.[2] We present a case of large rhinolith, arising on a foreign body.


  Case report Top


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
,
Figure 3: The removed rhinolith with foreign body

Click here to view



  Discussion Top


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.[1] Its literal meaning is “stone of the nose.”[2],[3] 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.[4]

The nidus might be endogenous or exogenous.[5] 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.[2] Rarely, they may cause palatal perforation.[4] 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.[2]

Nowadays, the fiber-optic nasal endoscopes can make the diagnosis extremely clear.[1] 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.[3],[5] 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.[4]


  Conclusion Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vedasalam S, Sipaul F, Hill A, Porter G. Nasendoscopy for unusual nasal symptoms.BMJ Case Rep 2010;2010:1-3.  Back to cited text no. 1
    
2.
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.  Back to cited text no. 2
    
3.
Singh AK, Gujar M, Shiral S, Raizada RM. Rhinolith: An unusual presentation. Indian J Otolaryngol Head Neck Surg 2004;56:297-8.  Back to cited text no. 3
    
4.
Shah FA, George S, Reghunanden N. A case presentation of a large rhinolith. Oman Med J 2010;25:230-1.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed409    
    Printed41    
    Emailed0    
    PDF Downloaded52    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]