Dr. T. Balasubramanian M.S.
Synonyms: Nasal calculi; Concretions in the
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
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.
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
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
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