Late-diagnosed bilateral congenital choanal atresia in adulthood: a case report

Choanal atresia is a congenital obstruction of the posterior nasal apertures, diagnosed in neonates due to respiratory distress. Adult presentations are exceptionally rare, particularly in bilateral disease. We report a 38-year-old woman with a 20-year history of progressive bilateral nasal obstruction, rhinorrhea, posterior nasal drip, nocturnal cough, hyposmia, oral breathing, and hypersensitivity to odors. She also reported chronic left-sided otologic symptoms since childhood, including persistent otorrhea, sensorineural hearing loss, tinnitus, and itching. Computed tomography imaging excluded nasal polyposis, and rigid and flexible endoscopy revealed complete bilateral choanal obstruction. Diagnosis was confirmed by nasogastric tube probing. Endoscopic resection of the bony and membranous atretic plates with right maxillary antrostomy was performed, followed by temporary stenting. The patient recovered without complications, and choanal patency was maintained at four months. This case highlights the importance of considering congenital choanal atresia in adults with long-standing nasal obstruction and supports endoscopic repair as an effective treatment.