Rhinolithiasis: Clinical Findings, Treatment Approach, and Associated Pathologies: A Single-Center Experience

Abstract

Aim: To identify the characteristics of rhinolithiasis in terms of its clinical, radiological, and surgical features in the largest case series in the literature. Material and Methods: A rhinolithiasis series comprising 32 cases that were treated at a single tertiary care center between 2014 and 2019 was reviewed retrospectively. The patients’ demographic characteristics, clinical features, rhinolith localization, accompanying sinonasal pathologies, and surgical data were noted. All patients underwent surgery via an endoscopic approach under general anesthesia, and any concomitant sinonasal pathology was treated during the same session. The patients were followed up with endoscopic examinations at the postoperative first and sixth months. Results: The sample consisted of 19 female (59.4%) and 13 male (40.6%) patients, with a mean age of 35.53±15.06 years. The most common symptoms were nasal malodor (65.6%), nasal congestion (53.1%), and purulent nasal discharge (15.6%). Rhinoliths were located in the right nasal cavity in 17 cases and the left nasal cavity in 15 cases. The most common localization of rhinoliths was between the septum and the inferior turbinate (65.6%). A nidus was detected in only four cases (12.5%), of which three belonged to an ectopic tooth. The most common concomitant nasal pathology was chronic rhinosinusitis (34.4%), followed by septal deviation (25%) and allergic rhinitis (9.4%). Endoscopic rhinolith excision was performed in 17 patients (53.1%), while surgical intervention was required for additional pathologies in 15 patients (46.9%). The most common simultaneous surgical intervention was septoplasty (15.6%). Conclusion: Rhinolithiasis should be considered in cases presenting with unilateral nasal symptoms that persist or worsen after initial treatment. Since the treatment of rhinolithiasis is surgical excision, the appropriate approach is the preoperative detection of pathologies which require additional surgery that can be simultaneously undertaken with rhinolith excision.