Rhinolithiasis as a Nidus for Polymicrobial and Anaerobic Colonization: A Case Report

Rhinolithiasis is a rare and underrecognized etiology of chronic sinonasal obstruction and rhinorrhea. The clinical presentation of rhinolithiasis often mimics chronic rhinosinusitis, though often presenting with unilateral symptoms. While most reported cases of rhinolithiasis focus on the clinical presentation and management, the microbiologic characteristics of rhinoliths remain poorly described. We report the case of a 55-year-old male with an 18-year history of persistent right-sided nasal congestion and rhinorrhea. Following nasal endoscopy and computed tomography evaluation, he was diagnosed with rhinolithiasis, and surgical management was recommended. The patient was lost to follow-up and returned three years later with persistent symptoms, at which point he elected to undergo surgical removal of the rhinolith. The patient underwent right maxillary antrostomy with tissue removal, right total ethmoidectomy, right rhinolith and foreign body removal, septoplasty, and left inferior turbinate submucosal resection under general anesthesia, and he experienced complete resolution of symptoms. Microbiologic cultures of the specimen demonstrated polymicrobial anaerobic growth, including Bacteroides, Streptococcus, and Escherichia coli. While culture data from rhinoliths are rarely reported in the literature, the organisms recovered in this case are consistent with the established flora of chronic rhinosinusitis, suggesting that long-standing rhinolith-associated obstruction may generate a microbiologic environment similar to that of chronic rhinosinusitis more broadly. This case highlights the importance of microbiologic evaluation of rhinoliths, as prolonged obstruction complicated by anaerobic colonization may predispose to disease chronicity and complications.