Rhinolithiasis: An unusual misdiagnosed entity

Abstract

Aim: To assess the usefulness of endoscopy in the initial visit for nasal obstruction in the outpatient department. Background: Rhinolith as the name suggests is stone formation in the nose. They are formed by gradual deposition of calcium and magnesium salts in a manner to encrust an endogenous (thick mucus, blood clot, and ectopic teeth) or exogenous (seed and cotton fiber) nidus of origin. The first documented case of the pathology was reported by Barthdinin in 1654. Since it is a slow-growing entity, it remains asymptomatic for a long period and often comes to light with presentation of unilateral nasal obstruction, foul smelling nasal discharge, cacosmia, and epistaxis. With its ability to cause rhinosinusitis and bony erosions of septum, lateral nasal wall, and hard palate, they are typically misdiagnosed. Case description: A young patient came with the history of nasal obstruction on the left side for the past 1 year. There was an intermittent history of a yellow, thick, foul-smelling, blood-stained nasal discharge. Nasal endoscopic examination revealed an irregular, dark, stony mass covered with secretions confirming a rhinolith, which was removed piecemeal. Conclusion: Considered as the cause of nasal obstruction and cacosmia, and many a times present in patients who have nasal complaints, delay in the diagnosis and treatment should be avoided. Rigid nasal endoscopy is the most important method to be used in diagnosis and treatment of rhinolith. Clinical significance: Presentation of rhinolith and diagnostic dilemma are discussed in this article so as to enable the attending clinician to be aware of this still prevailing condition and to prevent complications, such as oroantral and oronasal fistulas, septal perforation, palatal perforation, bony destruction of the maxillary sinus, frontal osteomyelitis, and epidural abscess.