A rhinolith is an object that has become lodged in the nose and has slowly calcified.1
Bartholin first identified rhinoliths in 1654. Since then, over 600 cases have been reported in literature. Their incidence is 1 in every 10 000 otolaryngology outpatients.2
Rhinoliths are rare and can have various clinical presentations. A high index of suspicion is required for the diagnosis of such a forgotten entity.3
Rhinolithiasis should be suspected in every case with unilateral, foul-smelling rhinorrhoea and nasal obstruction.4
Sometimes they may cause complications, such as unilateral nasal obstruction, fetid rhinorrhoea or epistaxis.5
Chronic nasal discharge without a history of rhinologic disease requires an endonasal examination under good conditions after retraction.6
This case illustrates that it is appropriate to perform endoscopy of the nasal cavities to investigate nasal obstruction before proceeding to surgery. The nasal bleeding and obstruction of 2 years’ duration experienced by this patient did not correlate with the extent of nasal septal deviation. Symptoms were severe enough for her to request referral to a specialist. If endoscopy had been performed, a general anaesthesia may have been avoided. However, based on previous experience, this may not always be the case as a rhinolith can be difficult to remove in clinic due to pain and possibly bleeding especially if it is posterior to a septal deviation.
All patients presenting for a specialist opinion for nasal obstruction should be seen by clinicians with access to flexible and rigid endoscopes in the out-patient department. This case illustrates the need to consider causes for nasal symptoms throughout the nasal cavity despite the presence of abnormalities anteriorly. Literature search did not show any other similar publications.
- If the presenting nasal symptoms do not completely correlate with the clinical findings nasal endoscopy should be performed to ensure that another abnormality is not missed.
- Full examination of the nose is likely to ensure that unusual pathology is not missed and allow appropriate treatment planning and patient counselling.
- Although rhinolith is a rare condition, it should not be forgotten as a cause for nasal obstruction.