Rhinoliths, also known as nasal calculi, are rare calcified lesions in the nasal cavity that usually result from a chronic inflammatory response to intranasal foreign bodies.
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Epidemiology
They are rare, one study estimated an incidence of only 0.01% of all ENT consultations 3.
Clinical presentation
Most rhinoliths ultimately produce clinical symptoms including unilateral purulent nasal discharge and nasal obstruction.
There may be a marked lag between the initial insertion of the foreign body and the symptoms (as long as decades).
Pathology
Rhinoliths usually result from a chronic inflammatory response to complete or partial mineralized encrustation of an intranasal nidus.
The nidus may be introduced from the outside, such as a piece of tissue, usually inserted by children or those with learning difficulties. Alternatively an endogenous element, for example a fragment of bone or dessicated mucus may promote rhinolithiasis 3.
Etiology
Rhinoliths are most commonly seen in children and cognitively impaired adults who insert foreign bodies into their nose.
Less frequently, trauma, surgery and dental work, nasal packing material, and plugs of ointment may also promote the development of a rhinolith.
Radiographic features
Rhinoliths are usually unilateral and solitary, and most commonly lie between the inferior meatus and nasal septum.
These lesions appear as a densely calcified mass in the nasal cavity, with displacement and expansion or destruction of the adjacent bony landmarks.
Treatment and prognosis
Usual treatment comprises removal of the rhinolith which unless easily accessible necessitates general anesthesia due to the difficulty inherent in retrieving it and associated hemorrhage 3.
Complications
Remote complications of rhinoliths remaining in situ include:
perforation of hard palate
bony destruction
erosion of rhinolith into maxillary sinus
facial spasms
History and etymology
The first published report of a calcified foreign body in the nose appeared in 1654, in which Bartholini described a stone-hard foreign body that had grown around a cherry stone. The term rhinolith was first coined in 1845 to describe a partially or completely encrusted foreign body in the nose.
Differential diagnosis
nasal foreign body
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