Rhinoliths

By

Dr. T. Balasubramanian M.S. D.L.O.

Synonyms: Nasal calculi; Concretions in the nose.

Rhinoliths are stone like calcareous deposits found inside the nasal cavity. These are of two types:

Exogenous rhinolith and Endogenous rhinolith. These concretions are common in the nasal cavities of females than in men. They may also occur although rarely in the naso pharynx. They are almost always single and unilateral. These masses are more or less irregularly spherical, they may also show prolongations according to their directions of growth.

The surface of a rhinollith is mulberry like, may be grey or brownish pink in color. Rhinoliths are friable, and they crumble readily under pressure. They are chiefly made of phosphates and carbonates of calcium. Sometimes phosphate of magnesia, chloride of sodium and carbonates of magnesia are also seen. These salts originate from the nasal mucous secretions, tears, and inflammatory exudates.

These salts have been found to be deposited around a nucleus which could be inspissated mucous, blood clot or a small foreign body. If concretions occur around a foreign body then the rhinoloith is known to be exogenous in nature and if if forms around a blood clot or inspissated mucous plug then it is known to be endogenous in nature. Gauze swabs inadvertantly left in the nose can also act as a nidus for the formation of rhinolith.

Symptoms:

These patients have unilateral nasal discharge, which may be serosanguinous in nature. As the rhinolith increases in size, the symptoms of nasal obstruction become more pronounced and the patient may manifest with unilateral purulent nasal discharge. Swelling of the nose, face epiphora could be some of the symptoms.

On probing the presence of a stony hard structure could be identified. It is common in the inferior meatus

Management:

Complete removal of the offending mass is the dictum. If the rhinolith is reasonably small it can be remove per via naturalis without incision. If it is large attempt must be made to break it to manageble pieces to facilitate per via naturalis removal. If attempts to break the mass fail then lateral rhinotomy should be resorted to for complete removal of the mass.

Once successfully removed it does not recur.

CT scan showing a rhinolith

Rhinolith seen after removal

Video clipping shows a rhinolith being removed