Rhinolithiasis is considered to be a rare entity in clinical practice and describes the formation of rhinoliths (or nasal calculi) in the nasal cavity [1] [2] [3] [4]. Rhinoliths are mineralized masses composed of calcium, phosphate, magnesium, iron, and other organic/inorganic materials, together with secretions and mucus from local tissue [1] [4]. They arise in the presence of a foreign body (authors have detected grains, stones, plastic, fruit seeds, insects, buttons, beads, pebbles etc. as objects that contribute to rhinolith formation) or are due to endogenous factors, such as blood clots, necrotic processes, or even teeth that behave as foreign bodies [1] [2] [5]. Insertion of foreign bodies is typical during childhood, which is why the majority of cases belong to pediatric and young adult population [2]. The pathogenesis of rhinolithiasis is incompletely understood but seems to involve local inflammatory changes and progressive accumulation of minerals and salts around the mass that might eventually produce symptoms [2]. Purulent discharge is the most commonly reported symptom by patients [5], whereas unilateral nasal obstruction, cacosmia (persistent sensation of a bad smell) or sometimes even anosmia (loss of smell), recurrent epistaxis, and headaches are other accompanying features [1] [2] [3] [5]. In addition, nasal swelling and deviation of the nasal septum, as well as epiphora may also be documented [3]. Studies have confirmed a very long clinical course of the illness, presumably because the initial event that led to the development of rhinolithiasis was either asymptomatic or gave rise to minimal complaints [3] [5]. As a result, symptoms last for months or even years before a diagnosis is made [3] [5]. Complications include the formation of an oroantral or oronasal fistula, anatomic disruption of the nasal wall or the palate, and chronic sinusitis [2] [6].

• Constitutional Symptom

  There were no constitutional symptoms. There was no history of trauma, foreign body insertion or any systemic illness. Otolaryngeal clinical examination revealed deviated nasal septum towards the left side. [omjournal.org]

  There was not any history of trauma, systemic disease, or constitutional symptoms. [thritajournal.com]

• Nasal Congestion

  A unilateral rhinorrhea, nasal congestion and a bad smell is the most common symptoms. In this study, the 39-year-old female patient was operated on for rhinolithiasis with the review of the literature is presented. [agris.fao.org]

  Our patients presented with foul-smelling nasal discharge and breath, halitosis, nasal congestion and facial pain. [entcase.net]

  It is very important to always consider it in patients with unilateral purulent nasal discharge, nasal congestion, oral malodor, chronic headaches, and recurrent epistaxis. [slideplayer.com]

• Snoring

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• Nasal Pruritus

  Case 7 E.M.O.N., 26-year-old female patient, was seen in the service of ORL-HUAP manifesting chronic nasal obstruction, purulent and fetid rhinorrhea, facial pain, especially on the interorbicular region, marked nasal pruritus, sneezing and anosmia for [oldfiles.bjorl.org]

• Postnasal Drip

  The first suggested mechanism is the persistent inflammation and chronic postnasal drip, which cause chronic low-grade inflammation and interfere with the physiologic regression of adenoid tissue. [academic.oup.com]

• Facial Pain

  RESULTS: Nasal obstruction appeared to be the chief symptom, followed by nasal discharge and facial pain. Neither exogenous nor endogenous nidi were identified in any of the cases. [ncbi.nlm.nih.gov]

  Our patients presented with foul-smelling nasal discharge and breath, halitosis, nasal congestion and facial pain. [entcase.net]

• Neglect

  Rhinolithiasis is a rare condition often neglected or unknown that tends to disappear in developed countries and corresponds to a solid calcification by gradual deposition of calcareous salts around a central resorbable or non-resorbable foundation of [ncbi.nlm.nih.gov]

  Rhinoliths result from neglected nasal foreign bodies that gradually increase in size. [entcase.net]

Because of the rather wide differential diagnosis (chronic inflammatory disorders and both benign and malignant tumors), the physician must obtain a detailed patient history and conduct a thorough physical examination [2] [4], perhaps the two most important steps for gaining sufficient evidence to make a presumptive diagnosis of rhinolithiasis. Patients (or parents in the pediatric setting) should be asked about a history of foreign body insertion into the nose [2], but they may not always recall the event [5]. Some studies have established that trauma, surgery, and dental work potentially promote the formation of rhinoliths [4], thus a comprehensive personal history is equally important. In the presence of persistent unilateral nasal obstruction and purulent rhinorrhea, however, clinical suspicion of rhinolithiasis must be raised [1]. After a complete nasal examination (through anterior rhinoscopy), imaging studies should be ordered. Although plain radiography might be of benefit in the assessment of the nasal cavity by being able to detect a dense, calcified mass, more advanced studies, such as computed tomography (CT), are favored [2] [3] [5]. Supplementary to CT and X-rays, nasal endoscopy has emerged as an important tool for diagnosing intranasal lesions [1] [2] [4] [5].

The treatment involves the removal of the rhinolith and the use of appropriate antibiotic therapy to control local infection. Rigid nasal endoscopy is the most important method to be used in diagnosis and treatment. [ncbi.nlm.nih.gov]

Diagnosis is sometime also made incidentally through routine examination or revealed by imaging examinations conducted for other reasons, such as dental treatment. [omjournal.org]

BACKGROUND: Rhinolithiasis is a rare and under-diagnosed clinical entity whose etiology and pathogenesis is poorly understood. [ncbi.nlm.nih.gov]

The etiology, clinical presentation, CT findings, and differential diagnosis in one case of rhinolith are presented in this report. Understanding this benign entity will allow its distinction from tumors of the nasal cavity. [link.springer.com]

The etiology is not always detected, and it may be exogenous (such as grains, small stone fragments, plastic parts, seeds, insects, glass, wood and others), or endogenous, resulting from dry secretion, blood clots, mucosal necrosis and tooth fragments [omjournal.org]

Etiology -Idiopathology -Pathology -Idioetiology Hepatogenous: originating where? -In the hepatic lobe -In the liver and bladder -In the liver -In the hepatic wall Choose the correct term for "surgical removal of a kidney". [quizlet.com]

Nasal saline irrigation under direct vision after removal of the rhinolith, was suggested previously in order to prevent revisions ( 7 ). [academic.oup.com]

The current case report stresses the importance of considering the possibility of rhinolithiasis in unilateral nasal obstruction and nasal discharge to prevent misdiagnosis and delayed diagnosis. [thritajournal.com]

1. Ozdemir S, Akbas Y, Görgülü O, Selçuk T, Sayar C. Rhinolithiasis: review of 21 cases. Am J Rhinol Allergy. 2010;24(6):136-139.
2. Dib GC, Tangerina RP, Abreu CE, Santos Rde P, Gregório LC. Rhinolithiasis as cause of oronasal fistula. Braz J Otorhinolaryngol. 2005;71(1):101-103.
3. Price HI, Batnitzky S, Karlin CA, Norris CW. Giant nasal rhinolith. Am J Neuroradiol. 1981;2:371-373.
4. Brehmer D, Riemann R. The Rhinolith—A Possible Differential Diagnosis of a Unilateral Nasal Obstruction. Case Rep Med. 2010;2010:845671.
5. Hadi U, Ghossaini S, Zaytoun G. Rhinolithiasis: a forgotten entity. Otolaryngol Head Neck Surg. 2002;126(1):48-51.
6. Ozcan I, Ozcan KM, Ensari S, Dere H. Rhinolithiasis with a nasal polyp: a case report. Ear Nose Throat J. 2008;87(3):150-151.