To report a case of unilateral choanal atresia diagnosed in a 48-year-old, presenting with fatigue as the major symptom. To highlight the importance of a detailed clinical history and physical examination for an accurate diagnosis.

Choanal atresia is an uncommon and often poorly recognized cause of unilateral or bilateral nasal obstruction. It is a congenital condition that occurs in approximately 1 in 5,000 to 8,000 live births.

This study reports a case of unilateral choanal atresia diagnosed in a 48-year-old presenting with fatigue as the major symptom. The patient presented with a lifelong history of tiredness investigated in cardiology. She was treated by a combined transseptal and transnasal endoscopic surgical technique. Topic use of mitomycin was performed with no use of stents, with clinical regression of the symptoms.

Unilateral choanal atresia usually presents in younger patients but can be undiagnosed until adulthood due to the nonspecific nature of the symptoms. This diagnosis should be, therefore, considered in all ages and bedside diagnostic procedures should, then, be done. Nasal endoscopy and computed tomography (CT) scan are the gold standard for the diagnosis. The use of stents and mitomycin C topically as an adjunct to the surgical repair of choanal atresia is a controversial subject.

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.