Letter to the Editor Rhinolith from a plastic object in the nasal cavity for more than 20 years Chia-Chi Cheng, 1,4 Tuan-Jen Fang, 1,4 Li-Ang Lee, 1,4 Hseuh-Yu Li, 1,4 Ying-Ling Kuo 2 and Tsung-Ming Chen 3 1 Department of Otolaryngology, Chang Gung Memorial Hospital, 2 Department of Dermatology, Mackay Memorial Hospital, 3 Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, Taipei, and 4 College of Medicine, Chang Gung University, Taoyuan, Taiwan Rhinoliths are rare foreign bodies in the nasal cavity formed by the mineralization of foreign material, including teeth, dried blood clots, fruit seeds, beads, buttons, pieces of dirt and pebbles, and the remains of a gauze tampon. 1 As pointed out by Ezsiás, foreign objects in the nose are common, but formation of a rhinolith is rare. 2 We report an unusual and interesting case of rhinolith forma- tion resulting from a plastic object lodged in the nasal cavity for more than 20 years. This case, which we believe is the first report of a hard plastic material forming a nidus for a rhinolith, illus- trates that adults can have foreign bodies in their nasal cavity, which date back to their childhood. We examined a 25-year-old woman with a history of right nasal obstruction, intermittent right epistaxis, and a foul- smelling nasal discharge. These symptoms had been present for many years with gradually increasing severity and she had became more aware of them over the past two years. An irregu- lar, moderate, porous, grayish-to-blackish mass along the right nasal floor was noted on physical examination. The mass was covered with some granulation tissue and embedded in the lateral nasal wall. A paranasal computed tomography scan (Fig. 1) revealed a calcified intranasal mass. A rhinolith was extracted in pieces without submucosal resection of the septum, under local anesthesia with the assistance of a rigid endoscope. The specimen consisted of seven pieces. The largest fragment of the specimen resembled a plastic accessory (Fig. 1, inset). The patient did not recall, however, that she had ever intro- duced such a foreign body into her right nostril. She said that her family had managed a workshop for the production of plastic accessories (candle holders for cakes) 20 years ago. The foreign body might have been introduced into her right nostril at that time, when she was still a little girl. We therefore sup- posed this foreign object had to have been lodged inside her nose for at least 20 years. Rhinoliths are calcareous concretions resulting from the depo- sition of salts on an intranasal foreign body. 3 Understanding these benign entities will allow for their early diagnosis and help to distinguish them from tumors of the nasal cavity. 4 A literature review indicated that rhinoliths are usually removed intranasally. 1 Some rhinoliths must be crushed and broken into smaller pieces to be removed from the nose. Furthermore, some patients require a submucosal resection of the septum to provide sufficient expo- sure for extracting the rhinolith. 1 Although our patient was an adult, she apparently had placed the plastic piece in her nasal cavity during her Correspondence: Tsung-Ming Chen, MD, no. 291, Jhongjheng Road, Jhonghe City, Taipei County, 235, Taiwan. Email: drkevin.cheng@ msa.hinet.net Institutional review board approval We obtained approval from our official institutional review board for this study. We also obtained informed consent from the patient before the procedure, in keeping with the mandate of the Declaration of Helsinki. Our patient was completely informed about the procedure to be performed in managing her condition. Received 1 March 2010; revised 29 July 2010; accepted 22 October 2010. Fig. 1 Paranasal computed tomography scan showing a mass with calcifications in the right nasal cavity, with displacement of the septum to the left. Inset: The plastic accessory removed from the nasal cavity. It resembles a candle holder for a birthday cake. The spines locked this foreign body in the nasal cavity and probably acted as the nidus for calcification. Pediatrics International (2011) 53, 135–136 doi: 10.1111/j.1442-200X.2010.03304.x © 2011 The Authors Pediatrics International © 2011 Japan Pediatric Society