Rhinolithiasis: the importance of flat panel detector-based cone beam computed tomography in diagnosis and treatment

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023

BACKGROUND

In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document.

METHODS

ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work.

RESULTS

ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost.

CONCLUSION

The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

Endoscopic Management of Rhinolithiasis: A Systematic Review

OBJECTIVE

This study reviews the presentation, management, and outcomes of patients with rhinolithiasis.

DATA SOURCES

An electronic database search of PubMed, SCOPUS, CINAHL, and the Cochrane Library was performed in accordance with the PRISMA 2020 updated guidelines for reporting systematic reviews.

REVIEW METHODS

Case reports and case series published from 2004 to 2020 were included. Data collected included patient demographics, clinical symptoms at presentation, diagnosis, treatment, complications, and follow-up. Relevant descriptive statistics were computed using Microsoft Excel 2013 (Microsoft Corp).

RESULTS

Fifty-five case reports and five case series were included (n = 122). The majority were female (60.7%). The mean age was 29.4 years (range, 4-80 years). The most common symptoms were rhinorrhea (81.1%), nasal obstruction (79.5%), nasal malodor (38.5%), and headache (27.9%). Computed tomography imaging was obtained in 109 (91.5%) cases. Concurrent rhinosinusitis (35.2%) and deviated nasal septum (28.7%) were commonly identified. Rhinoliths were commonly found in the right nostril (52.5%) and in between the inferior turbinate and nasal septum (26.9%). All rhinoliths were fully excised using endoscopic sinonasal surgery, accompanied by a septoplasty (9.2%). The nidus was identified in 27 (22.2%) patients. There were no recurrences or complications over an average follow-up of 8.5 months (range, 0.25-36 months).

CONCLUSION

Rhinolithiasis is an uncommon entity of the nasal cavity and should be suspected in patients with long-standing unilateral nasal obstruction, rhinorrhea, and nasal malodor. Rigid nasal endoscopy and endoscopic sinonasal surgery are the most important methods for diagnosis and treatment, respectively.

Suspected Rhinolithiasis Associated With Endodontic Disease in a Cat

Rhinoliths are rare, intranasal, mineralized masses formed via the precipitation of mineral salts around an intranasal nidus. Clinical signs are typically consistent with inflammatory rhinitis and nasal obstruction, but asymptomatic cases are possible. Rhinoliths may be classified as exogenous or endogenous depending on the origin of the nidus, with endogenous rhinoliths reportedly being less common. This case report describes a suspected case of endogenous rhinolithiasis in a cat which was detected as an incidental finding during radiographic assessment of a maxillary canine tooth with endodontic disease. Treatment consisted of removal of the suspected rhinolith via a transalveolar approach after surgical extraction of the maxillary canine tooth.

Rhinolith misdiagnosed as allergic rhinitis: case report

Foreign body neglected in the nasal cavity for many years leads to the formation of a rhinolith, which gradually increases in size. Nasal obstruction and persistent foul smelling nasal discharge usually are the main presenting symptoms, although some might be silent. This paper presents and discuss a case of 19-year-old female patient whose main complaint was nasal obstruction for many years and treated as allergic rhinitis. Diagnosis was confirmed with computed tomography scan, and it was removed endoscopically without complications. We think that proper examination, which includes endoscopic evaluation, should be done to reach the diagnosis. A computed tomography scan confirmed the diagnosis and helped in planning the best treatment option.

Clinical and radiological aspects of rhinoliths: report of five cases

Rhinoliths are calcified masses in the nasal cavity caused by the deposition of nasal, lacrimal, and inflammatory mineral salts by accretion around an endogenous or exogenous nidus. Rhinoliths can be seen as incidental findings on panoramic radiography, although they typically appear blurred due to remaining outside the focus. Therefore, rhinoliths may be difficult to recognize; this difficulty can lead to misdiagnosis. Computed tomography (CT)/cone beam CT (CBCT) scans are generally necessary to define the precise location and to make a differential diagnosis. This article describes radiologic features of five cases of rhinoliths that were detected incidentally on panoramic radiographs. CT or CBCT images were obtained before removing the rhinoliths.

Longstanding rhinolith leading to anatomical alterations of the ipsilateral inferior nasal meatus and turbinate

Rhinoliths consist of a central nidus with calcification resulting in calcareous concretions within the nasal cavity. They are uncommon in the literature despite a propensity particularly in children to insert foreign bodies into their nose and ears. We present the case of a 62-year-old woman with a longstanding undetected rhinolith with mild uncharacteristic symptoms. Radiographic examination revealed anatomical alteration of the inferior turbinate that was attributed to the long presence of the rhinolith in the nasal cavity. The management of the rhinolith and a review of the literature are presented.

Nasendoscopy for unusual nasal symptoms

A 20-year-old woman who was fit and well presented with a history of left nasal blockage for 2 years. She was noted on anterior rhinoscopy to have nasal septal deviation towards the left. She was listed for septoplasty with the aim of relieving nasal obstruction. At operation she was found to have a mildly deviated septum to the left. There was also a rhinolith in the left nostril posterior to the deviated septum (figure 1). Following removal of the rhinolith, her nasal airway appeared adequate; hence, septoplasty was not performed. Postoperatively, the patient was pleased with the outcome. When the patient was shown the foreign body she recalled inserting a pen cover into her nose about 10 years previously (figure 2). When she presented to the Accident and Emergency department at that time she was told that there was no foreign body in her nose.