Case Report of a Large Rhinolith Cast – A Frequently Missed Diagnosis

Abstract

Background: Rhinoliths are calcified or mineralized concretions that are deposited around a nucleus and are usually unilateral. They are rare with an estimated incidence of 1:10000 of all ENT outpatient cases. This may be an underestimation as many cases remain asymptomatic since the process may take years to develop. Case Report: We report a case of unilateral nasal obstruction since childhood in an adult male where the diagnosis remained obscured until thorough assessment was done. According to the anterior rhinoscopic and nasoendoscopic examination, there was an irregular bony mass occupying the left nasal cavity from the floor to the middle meatus. The diagnosis of rhinolith was confirmed by nasoendoscopy and non-contrast CT (NCCT) scan, and it was removed piecemeal from the nose. Conclusion: This case underlines the importance of a detailed clinical and endoscopic examination of the nose in adult cases with unilateral nasal obstruction. It also highlights the potential for misdiagnosis of such cases at the hands of general practitioners or physicians and the importance of early referral to an otolaryngologist in case of treatment failure by established protocols.