Rhinolith

RHINOLITH (from the Greek rhis, rhinos—nose and lithos—stone), or nasal stone, is a concretion formed in the nasal cavity from the secretion of its mucous membrane, as well as from lacrimal fluid penetrating into the nose, as a result of the precipitation of salts from solutions. The presence of nasal stones in the nose was first mentioned in the literature in 1654 (Bartholin). Rhinoliths are concretions consisting of organic and inorganic material of the most diverse shape and size; they are sometimes smooth, sometimes uneven, rough, angular, and as if eroded; their size ranges from a pea to a walnut and larger (a case has been described where the weight of a rhinolith reached 12 g). They are colored grayish-red, yellowish, dirty, or blood-stained. The consistency is sometimes dense, sometimes brittle and friable. In the nasal cavity, they are usually located in the inferior nasal meatus, less often in the middle, and for the most part, they are singular. Rhinoliths usually develop around a foreign body that has entered the nose, which can be of organic or inorganic origin (e.g., a blood clot, a fruit seed, a pebble, etc.) and which is found in the center of the stone upon sawing it open. In other, rarer cases, no foreign bodies are found in the stones. In some industries (at tobacco factories, cement plants), inhaled dust can trigger the formation of rhinoliths. Chemical analysis shows that the composition of rhinoliths includes calcium and magnesium phosphate and carbonate, organic substances, and water. The cause of stone formation is generally not entirely clear; apparently, an inflammatory state of the mucous membrane plays a role, and it is possible that the presence of microorganisms is significant. Rhinoliths are not often encountered, sometimes in childhood (one has been described in a 3-year-old child). There are indications in the literature that a stone formed within 2 months. A stone can remain in the nose for decades. Symptoms of a rhinolith mainly amount to phenomena of chronic rhinitis, sometimes purulent, to nasal obstruction on one side, and to nosebleeds, which is explained by the development of bleeding granulations around the stone. There may also be referred phenomena in the form of neuroses (headaches, cough, asthma) due to the irritation of nasal nerves by the rough outgrowths of the rhinolith. The diagnosis is made on the basis of history, rhinoscopy, and probing. Removal of the rhinolith from the nose is performed under local cocaine-adrenaline anesthesia using various types of forceps, tweezers, and sponge forceps; often, with large stones, it is necessary to first crush and break them down with strong forceps.