When the symptoms remain, the diagnosis may need a change: a missed foreign body

The unilateral nasal symptom should trigger a treating physician to a certain diagnosis. The differential diagnosis includes foreign body, rhinolith and tumour. The chronicity of symptom helps a lot with the diagnosis. Foreign body for example, tends to present with positive history of insertion, mainly by children or the acute symptom of local infection. In the presence of prolonged symptom, rhinolith should be suspected especially when the patient presents with pathognomonic nasal obstruction with foul smelly discharge. A referral should be made for a nasoendoscopy evaluation whenever a rhinitis-like symptoms remain after a period of medical treatment for allergy. We share a case of a missed diagnosis of a rhinolith after six years of symptoms.