Rhinolithiasis, a Rare Entity: Analysis of 31 Cases and Literature Review

Abstract

OBJECTIVE: Rhinolithiasis is a rare condition which results from deposition of salt around a endogenous or exogenous nidus. In the literature, most of the reports are single case studies. In this study, we aimed to present the characteristics, symptoms, diagnosis, and treatment methods of 31 rhinolithiasis cases and to focus on the current literature. METHODS: We retrospectively reviewed 31 rhinolithiasis cases which have been diagnosed and treated in a tertiary care center between January 2014 and December 2018. Patient characteristics, presenting symptoms, concomitant sinonasal disorders, and type of surgery were noted. Descriptive statistics were carried out. RESULTS: Mean age was 25.4±15.7. The cases were comprised 14 female patients (45.2%) and 17 male patients (54.8%). The most common presenting symptom was nasal obstruction (71%). Malodorous unilateral rhinorrhea was present in 17 patients (54.8%). Epistaxis snoring and sleep apnea were other rare symptoms. In 21 of the cases (67.7%), rhinolith was located between inferior turbinate and septum which was the most common location seen in our series. The number of patients who were under the age of 18 was 13, in 2 of them, rhinolith was found to be formed around a plastic bead, and in 2 of them, fruit seeds were the nidus. The most common concomitant sinonasal pathology was septal deviation which was detected in 20 of the patients (64.5%), adenoid vegetation and nasal polyposis were other disorders. In 20 of the patients (64.5%), simple removal of the rhinolith using a forceps with the help of a rigid nasal endoscope was performed. Eight of the 17 patients had severe deviation and septoplasty was performed at the same time, which was the most common concomitant surgical intervention (25.8%). In 3 patients (9.6%), functional endoscopic sinus surgery was performed at the same time. CONCLUSION: Our series is one of the largest series in the literature. The most common presenting symptom was nasal obstruction followed by malodorous rhinorrhea. Accompanying sinonasal disorders should be addressed to improve the outcome. Rigid or flexible endoscopic examination should be used to detect a rhinolith. Computed tomography scan can diagnose a hidden rhinolith in a patient with nasal obstruction.

Rhinolithiasis misdiagnosed as intranasal osteoma: Diagnostic challenges in the telehealth era

“…The differential diagnosis for calcified intranasal lesions should include intranasal osteoma, rhinolith, calcified foreign body, ectopic tooth, ossifying fibroma, and aspergillosis. Osteomas are more likely to occur in the frontal, ethmoid, maxillary, or sphenoid sinuses, and only rarely present intranasally or associated with a turbinate, 11 contrasting with rhinoliths, which most commonly present between the inferior turbinate and the septum, 1,8 as seen in this case. Foreign bodies are less likely to present in adulthood, though may serve as a nidus for rhinolith formation.…”

“…13 Rhinolith, unique from each of these discussed pathologies, is most commonly seen between the inferior turbinate and the septum, as seen in this patient's case, with imaging showing radiopaque calcifications and central radiolucency if surrounding an organic nidus. 1,8 While CT imaging is important, definitive diagnosis requires endoscopic examination and may be aided with palpation, as demonstrated in this case. Endoscopy typically demonstrates a solid, mineralized mass of the nasal cavity that can be somewhat mobile.…”

“…1,8 Palatal and septal perforation are rare complications of rhinolithiasis. 8 Despite characteristic imaging and presentation, these symptoms and findings frequently overlap with other intranasal pathologies, necessitating in-person assessment and endoscopic evaluation. Herein, we report the case of a 50-year old patient whose rhinolithiasis was initially misdiagnosed as intranasal osteoma via telehealth, with the aim of creating awareness of the elements of presentation and imaging unique to rhinolithiasis, while highlighting the importance of in-person evaluation and endoscopy to assure diagnostic accuracy and appropriate treatment.…”

A missed giant rhinolith retained for a decade in a paediatric patient at a zonal referral hospital in Central Tanzania: Case report and literature review

“…Description of rhinolithiasis can be dated back to 1654 when Bartholin first described it [2] . A rhinolith is formed by gradual deposition and coating of different salts of calcium and magnesium over an endogenous or exogenous nidus in the nasal cavity [1] , [3] , [4] , [5] .…”

A Case of Fungus Ball in the Nasal Cavity Imitating a Rhinolith

“…Rhinoliths are rare calcified foreign bodies that form gradually in the nasal cavity through the mineralization of an organic or inorganic, exogenous or endogenous nidus. 1 Rhinoliths are asymptomatic and can be detected incidentally. When symptomatic they can lead to unilateral purulent discharge, nasal obstruction, facial pain, and epistaxis.…”