Bilateral Choanal Atresia in a 65-Year-Old Female: A Case Report and Literature Review.

Background: Choanal atresia (CA) is a congenital condition characterized by occlusion of the nasal airway due to failure of recanalization during embryological development. It is more commonly unilateral and typically presents during infancy. In contrast, bilateral CA is a neonatal emergency that often manifests as respiratory distress at birth. The presentation of bilateral CA in late adulthood is extremely rare. Case Description: This case presents an unusual case of an elderly patient diagnosed with bilateral CA at 65 years. She presented with a primary complaint of lifelong bilateral nasal obstruction and denied any symptoms suggestive of chronic rhinosinusitis. Examination revealed bilateral choanal obstruction with no visible openings in the nasal cavity. The patient underwent endoscopic transseptal repair of bilateral CA, which included perforation of the atretic plate, posterior septectomy, and flap reconstruction. Postoperative evaluation demonstrated bilaterally patent choanae, and the patient remained asymptomatic, with no further complications. Conclusion: This case highlights a rare presentation of bilateral CA diagnosed in late adulthood. Although typically detected in the neonatal period, bilateral CA can occasionally remain undiagnosed for decades. This patient represents the oldest reported case of bilateral CA in the literature, emphasizing the variability in clinical presentation and the potential for delayed diagnosis.