Rhinolith a rare presentation in adolescent age group

Abstract

Rhinolith is rare calcareous concretions that are formed by the deposition of salts on an intranasal foreign body. The foreign body acts as a nidus that causes obstruction of nasal secretions, acute and chronic inflammation, deposition of minerals and enzymatic activities of bacterial pathogens, leading to slow and progressive increases in size. Symptoms are normally progressive unilateral nasal obstruction, rhinorrhea (usually purulent and fetid), cacosmia, and epistaxis. Other less common symptoms include headaches, facial pain, and epiphora. They are usually found in the anterior part of the nasal cavity and are usually diagnosed on history and anterior rhinoscopy. A 16-year-old female presented with complains of headache, difficulty in breathing from left nostril, prolonged runny nose with foul smell, and at times bloody nasal discharge for the 1 year. Otolaryngeal clinical examination revealed deviated nasal septum toward the right side. The left nasal cavity appeared wide with a hard mass lying on the floor of the left nasal cavity which was irregular in shape with a rough surface and was slightly mobile but tender and with bleeding tendency. A diagnosis of rhinolith was clinically made, and the patient was admitted for removal of the rhinolith. Computed tomography paranasal sinuses were done, the impression was irregular shaped calcified rhinolith seen in left nasal cavity. Although rhinoliths are rare, attending clinicians should keep in mind during the examination of patients. It requires a high index of suspicion when dealing with nasal symptoms such as progressive unilateral nasal obstruction, rhinorrhea (usually purulent and fetid), cacosmia, and unilateral nasal bleeding.