Late-diagnosed unilateral choanal atresia in a geriatric patient: a case report and literature review

Abstract

Choanal atresia (CA) is a rare congenital bony or membranous occlusion of the posterior nasal passage. Unilateral cases often evade detection until late life due to compensatory mechanisms and subtle symptoms, rendering diagnoses beyond the seventh decade exceptionally uncommon, with fewer than 20 cases reported in the literature. We present the case of a 77-year-old woman with a decades-long history of intermittent left-sided nasal congestion. Diagnostic nasal endoscopy revealed complete bony obstruction of the left choana, confirmed by computed tomography, which showed an isolated unilateral CA without syndromic features or comorbid sinonasal disease. A multidisciplinary evaluation deemed surgical correction unnecessary, given her minimal functional impairment, advanced age, and satisfaction with daily activities. Conservative management with saline irrigation and observation was selected, and the patient remained stable at the 6-month follow-up. This case highlights the diagnostic challenges associated with unilateral CA in older adults. It supports symptom-guided, individualized management over routine interventions in low-risk geriatric patients, as informed by a review of historical and contemporary strategies.