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Unilateral rhinorrhea and nasal obstruction in an adult
R Pérez-Calderón1, M Gonzalo Garijo, L Fernández De Alarcón
1Allergology Department. Infanta Cristina Hospital, Badajoz, Spain. seporcel@yahoo.es
Background:
choanal atresia is an uncommon malformation, consisting of congenital blockage of one of both choanae. Symptomatology varies according to the type of atresia and the age of the patient. The bilateral, or complete, form presents in newborns as respiratory distress while unilateral, or incomplete, forms present in older children or adults.
Case Report:
a 16-year-old girl presented with a lifelong history of right-sided nasal blockage and unilateral watery rhinorrhea. The rhinorrhea increased when the patient bent her head forward. Treatment with antihistamines and topical nasal corticosteroid sprays produced little improvement. The patient's previous medical history was unremarkable except for the expulsion of a coagulated mass through the right nostril a few days after birth, and event that provoked her symptoms. Physical examination was normal except for excoriation of the right external nasal margin. Anterior rhinoscopy revealed watery rhinorrhea, erythematous mucosa in the right nasal cavity and deviated nasal septum. No nasal masses or polyps were found. Physical examination confirmed the absence of ventilation in the right nasal airway and nasal endoscopy indicated right choanal obstruction.
Diagnostic Test:
skin prick tests with aeroallergens were positive for grass pollen and negative for all other allergens tested (mites, moulds, latex, and epithelia). Total IgE was normal (9 IU/ml). No eosinophilia was detected in the nasal secretion specimen. The results of laboratory tests including complete blood count and differential, erythrocyte sedimentation rate, and biochemical parameters were normal. The glucose level in nasal secretion was 4.6 mg/dl. X-rays of the paranasal sinuses and cavum showed no anomalies. Axial fine-cut computed tomography scans (3 3 mm) revealed choanal obstruction with bony and membranous components.
Conclusions:
a diagnosis of congenital choanal atresia should be considered in cases of unilateral blockage and rhinorrhea. Nasal endoscopy and computed tomography scans are essential to establish diagnosis.