Rhinolith of the nasal septum

Rhinolith in the concha bullosa as a rare location: a case report

The presence of a rhinolith is a rare condition, which can cause long-standing symptoms, such as rhinorrhea, foul-smelling discharge, nasal obstruction, and headache. A rhinolith is usually easily diagnosed by a clinical examination and a paranasal computed tomographic scan. Rhinoliths are usually found in nasal cavities, but rare locations are also possible. We report a patient who was evaluated in our clinic for nasal obstruction, headache, and snoring symptoms. A clinical examination showed no major findings, but a paranasal computed tomographic scan of coronal sections showed a hyperdense mass within the right concha bullosa. A rhinolith in the concha bullosa is a rare condition. Our case is the third case of a rhinolith in the concha bullosa to be reported in the literature.

A rhinolith surrounded by a nasal polyp

Rhinoliths are uncommon mineralized nasal mass in children and adolescents. We reported a case of unilateral rhinolith that presented as a nasal polyp. A 29-year-old woman who had right-sided nasal purulent discharge, nasal obstruction, intermittent epistaxis, and posterior nasal drip for 6 months was admitted to our department. Nasal examination revealed a nasal mass between the inferior turbinate and the nasal septum, presenting as a nasal polyp or a nasal tumor. Paranasal sinus computed tomographic scan confirmed a calcified mass in soft tissue. We removed the rhinolith and the soft tissue that was around it with a transnasal endoscopic approach. Histologic analysis of the soft tissue identified inflammatory nasal polypoid tissue.

[General review of rhinolithiases]

OBJECTIVE

The aim of this study was to analyze the clinical presentation and characteristics of rhinolithiasis, a rare and forgotten entity.

METHODS

Between 1990 and 2007, 20 cases of rhinolithiasis presented for consultation. The clinical course noted chronic nasal discharge associated with nasal obstruction. The protocol was the same for all patients: history of disease, meticulous endonasal endoscopy and plain radiography (+/-CT scan).

RESULTS

Rhinolithiasis was found in adults (55%), females, patients living in rural areas (66%) with unfavorable socioeconomic conditions. The diagnosis delay varied between six months and eight years. The examination showed the rhinolith in the form of a grey concretion, primarily unilateral and on the right-hand side in 60% of the patients. Only one bilateral case presented following destruction of the posterior nasal septum. The rhinolith measured between 5 and 50mm in diameter with only three associated foreign bodies (15%). The rhinolith was extracted through the natural pathways under local anesthesia in 60% of the cases. Complications were rare (epistaxis 10%) and favorable progression without recurrence was generally observed after a mean 16 months of follow-up (range, six months to 11 years).

CONCLUSION

Chronic nasal discharge without a history of rhinologic disease requires an endonasal examination under good conditions after retraction. Rhinolithiasis is easily recognized, in particular on imaging studies. Treatment is simple and curative in the majority of cases.

Report of an Unusual Cause of Rhinolithiasis: An ‘Opioma'

We report an unusual case of unilateral rhinolith. The patient was a 21-year-old man who had a history of left-sided nasal obstruction and recurrent bouts of fetid, purulent rhinorrhea of several years’ duration. The rhinolith, which had formed around an impacted foreign body, was extracted in several pieces under local anesthesia. Laboratory evaluation revealed that the foreign body was a hardened mixture of codeine and opium wrapped in a small sheet of nylon—what we called an “opioma.”

Rhinolithiasis: An uncommon entity of the nasal cavity

Rhinoliths are uncommon foreign bodies of the nose formed by in situ calcification of intranasal endogenous or exogenous foreign material. They are often an asymptomatic condition diagnosed accidentally during a routine examination. Although nasal foreign bodies are more frequently seen in children, and appear to be more common in women, they have been reported in patients of all ages. This article describes a case of rhinolith involving a 38-year-old male. The etiology, thin-sectioned microscopic findings, differential diagnoses, and treatment are also discussed.

The importance of rigid nasal endoscopy in the diagnosis and treatment of rhinolithiasis

OBJECTIVES

Rhinolithiasis is the presence of mineralized and calcareous formations located in the nasal cavity. They have rare occurrence and can be easily confused with infection or obstruction of upper airways. If they are undetected for a long time, they may grow large enough to cause of nasal obstruction, mimicking sinusitis. Seven cases of rhinolithiasis were presented, and their diagnosis was made by rigid endoscopic nasal examination. Also computerized tomography scan was used to describe the size and site of the rhinoliths accurately. Our purpose was to determine the role of rigid nasal endoscopy in the diagnosis and the treatment of rhinolithiasis.

METHODS

In this study, seven cases of rhinolithiasis, who were diagnosed and treated by rigid nasal endoscopy were presented.

RESULTS

Between January 2000 and November 2004, seven cases (four males and three females; age ranged from 8 to 45 years) with rhinolithiasis were diagnosed. The most frequent symptoms were nasal obstruction with purulent rhinorhea, nasal and oral malodor. As complementary examinations, computerized tomography and simple X-ray of paranasal sinuses were used to locate and measure the dimension of calcareous mass, and to reveal possible invasion of the adjacent structures. The removal of rhinolithiasis was done with rigid nasal endoscopy under topical anesthesia in six cases and general anesthesia in one case.

CONCLUSION

Rhinolithiasis is a rare condition but must always be suspected in patients with long standing nasal obstruction, nasal and oral malodor, purulent rhinorrhea and chronic headache.