Simultaneous bilateral choanal and nasopharyngeal stenosis in an adult patient: case report and treatment approach

Choanal and nasopharyngeal stenosis in adults are extremely rare. They usually are detected and treated in pediatric age as they typically result from congenital malformations. In adulthood, they mostly result from acquired causes such as iatrogenic trauma after surgeries, infectious or autoimmune diseases, or radiotherapy. However, sometimes it is not possible to determine the exact etiology. Treatment is challenging, with restenosis being the most feared and frequent complication. With this case report, we aimed to highlight the diagnostic and treatment approaches for choanal and nasopharyngeal stenoses in adults. We present a 61-year-old patient with persistent bilateral nasal obstruction and discharge, snoring, and recurrent frontal headaches for years which turned out to be a bilateral choanal and nasopharyngeal stenosis. Previously, the patient had been diagnosed with chronic rhinosinusitis without any other relevant medical history. Additionally, no previous surgical procedures or radiation therapy were found to be associated with the etiology. The patient was treated with surgery. A combined modality of trans-nasal endoscopic excision of choanal and nasopharynx fibrous tissue using cold cutting instruments and posterior septectomy followed by the topical application of Mitomycin-C, without stenting, was an effective option.