In Strilya, doctors at Sydney’s Westmead Hospital recovered a balloon containing cannabis from an unnamed man’s nose after he had attempted to smuggle it into a prison 18 years before. The tale was told in the Case Reports section of the British Medical Journal in an article bearing the title A nose out of joint. It appeared on October 15 2019. The lead author was Dr Murray Smith, who works for the hospital.

18 years prior, the man was a prison inmate whose girlfriend passed him a small quantity of cannabis when she visited him. The drug was within a rubber balloon which he inserted to his right-hand nostril. The package escaped the attentions of the prison officers but the man accidentally pushed it further up his nostril. He mistakenly thought he’d swallowed it.

Nose stones

In the course of the forthcoming 18 years, calcium and magnesium salts and other minerals built up around the balloon and it hardened to become a rhinolith – a so-called nose stone that can be an obstruction. This was 19 by 11 mm (0.748 by 0.433 inches) large. The man was struck by repeated nasal obstructions, sinus infections and headaches without realising the true cause. Prompted by severe headaches, he eventually consulted a doctor. The now-48-year-old man’s brain underwent a CT scan. This found the thingy up his nostril, which turned out to be “a rubber capsule containing degenerate vegetable/plant matter.”

Removal of the object was by surgery while the man was under anaesthetic. What became of the 18-year-old dope went undisclosed. The gent remembered the prison incident when he was questioned afterwards. Three months later, he was entirely free of symptoms. This seems to be the first instance of cannabis intended for prison turning into a rhinolith; the BMJ termed it a “unique case”. The usual procedure is to swallow a package and then retrieve it when it comes out “the other end” later on. According to the report, it’s “relatively rare” to stick them up a nostril.

Rhinoliths arrived in 1654

Rhinoliths were first documented by the Danish anatomist Caspar Bartholin in 1654; that one was caused by a cherry stone. They are more common in the right nostril than the left because people are more likely to be right handed. They are also more common in wimmen, possibly because wimmen blow their noses less forcefully and so are less likely to expel foreign bodies.

Rhinoliths form around foreign objects that might be exogenous, usually beads or seeds, or endogenous, such bodily matter as blood clots or dislodged teeth. In children, blocks of Lego are another possibility. Rhinoliths account for about one in 10,000 outpatient visits to ear, nose and throat specialists, but this is likely to understate the situation because often no symptoms transpire. In addition to nasal obstruction and headaches, discharge from the nose so foul-smelling that those around the sufferer can notice it, facial pain and decreased sense of smell can result.

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