Bilateral congenital choanal atresia in a 16-year old girl at Muhimbili National Hospital, Tanzania

Background: Bilateral choanal atresia refers to a congenital anomaly whereby a child is born with bilateral imperforate posterior nares. In most cases the diagnosis is established soon after birth. Establishment of the diagnosis requires a high index of suspicion by clinicians. The objective was thus to report an unusual case which went undiagnosed for many years and review the few available literatures.
Case presentation: A 16-year old girl presented to the otorhinolaryngology clinic of Muhimbili National Hospital in Tanzania with a long standing history of bilateral nasal obstruction. The condition was reported to be present since birth and this was accompanied by mouth breathing and persistent bilateral nasal discharge. The patient also reported a history suggestive of respiratory distress after birth which necessitated oxygen therapy and difficulty in breastfeeding where she was kept on expressed breast milk during the first few weeks of life. Nasal endoscopy was done clinic and the diagnosis of bilateral congenital choanal atresia was made. Computerized tomography scan of the nose and paranasal sinuses revealed bilateral choanal atresia of mixed type. Surgical perforation of the atretic choanae without stenting was done endoscopically under general anaesthesia.
Conclusion: Bilateral congenital choanal atresia is an otorhinolaryngological emergency and should be established promptly both in resource limited settings and in areas where advanced tools are in situ to prevent its morbidity and mortality if it goes unestablished.