Bilateral rhinoliths causing long-standing nasal obstruction: a case report and review of the literature

Abstract

BACKGROUND: Rhinoliths are uncommon calcified masses in the nasal cavity, typically unilateral. Bilateral rhinolithiasis is extremely rare-with fewer than 10 bilateral cases documented in the literature-and can present with chronic nasal obstruction and significant diagnostic challenges. CASE PRESENTATION: A 55-year-old Ethiopian man presented with a 10-year history of bilateral nasal obstruction, foul-smelling discharge, epistaxis, facial heaviness, and headache, previously treated as chronic rhinosinusitis with only temporary relief. Nasal endoscopy revealed bilateral stony masses extending to the choana and nasopharynx, and CT imaging showed well-defined hyperdense lesions without bony erosion or sinus involvement. The patient underwent successful endoscopic removal under general anesthesia, extracting large bilateral rhinoliths (approximately 3 × 4 cm). Histopathology confirmed laminated mineralized structures consistent with rhinoliths. The patient had immediate symptom resolution, and no recurrence was noted at 6-month follow-up. CONCLUSION: Bilateral rhinolithiasis, though rare, should be considered in patients with long-standing nasal obstruction and malodor, even when symptoms are bilateral. Endoscopic removal is safe and effective, with excellent outcomes and low recurrence risk. This case highlights the importance of thorough endoscopic and imaging evaluation in chronic nasal obstruction unresponsive to medical therapy.