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

Mohamed Gad; Ahmed Alomairin; Asmah Alhubaishi; Rahaf Alhajji

doi:10.18203/issn.2454-5929.ijohns20261864

Authors

Mohamed Gad Department of Otolaryngology-Head & Neck, John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
Ahmed Alomairin Department of Otolaryngology-Head & Neck, John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
Asmah Alhubaishi Department of Emergency, King Fahad Hospital Al Hofuf, Saudi Arabia
Rahaf Alhajji Department of Emergency, Prince Saud Bin Jalawy Hospital - Alahsa, Saudi Arabia

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20261864

Keywords:

Choanal atresia, Nasal obstruction, Elderly, Case report

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.

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References

Benjamin RH, Marengo LK, Scheuerle AE, Agopian AJ, Mitchell LE. Prevalence and descriptive epidemiology of choanal atresia and stenosis in Texas, 1999-2018. Am J Med Genetics Pt A. 2024;194(6):e63549. DOI: https://doi.org/10.1002/ajmg.a.63549

Durmaz A, Tosun F, Yldrm N, Sahan M, Kvrakdal C, Gerek M. Transnasal endoscopic repair of choanal atresia: results of 13 cases and meta-analysis. J Craniofac Surg. 2008;19(5):1270-4. DOI: https://doi.org/10.1097/SCS.0b013e3181843564

Gujrathi CS, Daniel SJ, James AL, Forte V. Management of bilateral choanal atresia in the neonate: an institutional review. Int J Pediatr Otorhinolaryngol. 2004;68(4):399-407. DOI: https://doi.org/10.1016/j.ijporl.2003.10.006

Al-Ghabra Y, Issa A, Ziadeh K, Ashrefa R, Mohsen ABA. Bilateral choanal atresia in an adult: a rare case report and a literature review. Otolaryngol Case Rep. 2025;36:100677. DOI: https://doi.org/10.1016/j.xocr.2025.100677

Urbančič J, Vozel D, Battelino S, Boršoš I, Bregant L, Glavan M, et al. Management of Choanal Atresia: National Recommendations with a Comprehensive Literature Review. Children. 2023;10(1):91. DOI: https://doi.org/10.3390/children10010091

Duggal P, Kajol R, Duggal KK. Unilateral choanal atresia: Presentation in adults. Indian J Otolaryngol Head Neck Surg. 2005;57(4):345-7. DOI: https://doi.org/10.1007/BF02907710

Ferraria L, Alves S, Rosa H, Santos M, Antunes L. Unilateral Congenital Choanal Atresia in a 48-Year-Old Patient. Int J Otorhinolaryngol Clin. 2017;9(1):28-31. DOI: https://doi.org/10.5005/jp-journals-10003-1257

Mengi E. Bilateral choanal atresia in a 60-year-old man: A case report and review of the literature. North Clin Istanbul. 2020;8(5):525-8. DOI: https://doi.org/10.14744/nci.2020.04557

Al-Noury K, Lotfy A. Role of multislice computed tomography and local contrast in the diagnosis and characterization of choanal atresia. Int J Pediatr. 2011;2011:280763. DOI: https://doi.org/10.1155/2011/280763

Šebová I, Vyrvová I, Barkociová J. Nasal Cavity CT Imaging Contribution to the Diagnosis and Treatment of Choanal Atresia. Medicina (Kaunas). 2021;57(2):93. DOI: https://doi.org/10.3390/medicina57020093

Messineo D, Chernikava M, Pasquali V, Bertin S, Ciotti M, De Soccio G, et al. Radiological Parameters Review for Choanal Atresia. Pediatric Rep. 2021;13(2):302-11. DOI: https://doi.org/10.3390/pediatric13020038

Gundle L, Ojha S, Hendry J, Rosen H. Stenting versus stentless repair for bilateral choanal atresia: A systematic review of the literature. Int J Pediat Otorhinolaryngol. 2021;151:110926. DOI: https://doi.org/10.1016/j.ijporl.2021.110926

Ouattassi N, Wissam El, Asmae A, Zaki Z, El Alami MN. Current Management of Congenital Choanal Atresia: Litteratur Review. Indian J Otolaryngol Head Neck Surg. 2023;75(3):2227-34. DOI: https://doi.org/10.1007/s12070-022-03398-2

Najeeb T, Ajmal M. Choanal Atresia Treated with Transpalatal Approach. J Coll Physicians Surg Pak. 2008;18(12):776-7.

Sajitha KB, Ihsan AT. Unilateral choanal atresia-presentation in varied age groups. JEMDS. 2015;04(18):3178-82. DOI: https://doi.org/10.14260/jemds/2015/460

Abraham ZS, Kahinga AA. Unilateral choanal atresia and a co-existent long-standing medium-sized ipsilateral rhinolith in a 15-year old boy: Case report and literature review. Int J Surg Case Rep. 2023;105:107999. DOI: https://doi.org/10.1016/j.ijscr.2023.107999

Qout MA, Alkarni A, Alaraifi A, Almahdi M. Bilateral Choanal Atresia in a 65‐Year‐Old Female: A Case Report and Literature Review. Case Rep Otolaryngol. 2025;2025:5584900. DOI: https://doi.org/10.1155/crot/5584900

Kadasah S, Qahtani AA, Al-Sayed G, Helali AA, Aldhabaan S, Musleh A, et al. Unilateral Choanal Atresia in Adults: A Case Series. IJOHNS. 2024;13(03):187-93. DOI: https://doi.org/10.4236/ijohns.2024.133018

Mohammadi G. Unilateral choanal atresia in adults. Pak J Med Sci. 2009;25(5):875-7.

Shute WG, Wong EH, Agar NJM, Singh NP. Unilateral choanal atresia first diagnosed in adulthood and repaired via endoscopic posterior septectomy-a case series and review of the literature. Aust J Otolaryngol. 2021;4:0-0. DOI: https://doi.org/10.21037/ajo-20-63

Sunil KC, Praveen Kumar BY, Mali K, M. K. VR. Unusual presentation of a unilateral choanal atresia in an adult: a case report. Int J Otorhinolaryngol Head Neck Surg. 2020;6(4):780. DOI: https://doi.org/10.18203/issn.2454-5929.ijohns20201298

Tatar EÇ, Özdek A, Akcan F, Korkmaz H. Bilateral congenital choanal atresia encountered in late adulthood. J Laryngol Otol. 2012;126(9):949-51. DOI: https://doi.org/10.1017/S0022215112001442

Yosunkaya MT. Unilateral Choanal Atresia in a 62 Years Old Patient. Am J Rare Dis Diagn Ther. 2020;3(1):1-3.

Thaller SR, Kawamoto HK. Unilateral choanal atresia in adults: a new surgical approach. Ann Plast Surg. 1988;20:356-9. DOI: https://doi.org/10.1097/00000637-198804000-00012

SciELO Brazil-Atresia coanal bilateral em paciente de 34 anos Atresia coanal bilateral em paciente de 34 anos. Available at: https://www.scielo.br/j/aio/ a/sjjFXzbmb8RBPj4hmtBdVTx/abstract/?lang=en. Accessed on 02 February 2026.

Achour I, Kharrat I, Ayed MB, Thabet W, Bouraoui A, Mnejja M, et al. Choanal atresia: Diagnosis and management. J Tun Orl. 2023;49:33-8.

Andaloro C, Winters R, Mantia IL. Choanal Atresia. StatPearls: StatPearls Publishing; 2025.