ANTROCHOANAL POLYP: AN UNCOMMON CAUSE OF CHRONIC NASAL CONGESTION IN PEDIATRIC PATIENTS

Abstract

<h3>Introduction</h3> Chronic nasal congestion is a common pediatric problem, caused most frequently by viral infections and environmental allergies. We describe a rare case of pediatric antrochoanal polyp causing nasal obstruction. <h3>Case Description</h3> A 10-year-old female with chronic nasal congestion, allergic rhinitis, snoring, recurrent sinus infections, and hyposmia was found to have a left-sided nasal mass after several years of progressive symptoms, despite treatment with nasal corticosteroids and anti-histamines. CT scan showed opacification of the left maxillary and sphenoid sinuses, bilateral ostiomeatal obstruction, and a small, lobulated mass obstructing the left nasal cavity. She had no other recurrent infections or family history of cystic fibrosis; immunoglobulin levels and sweat testing were normal. After otolaryngological evaluation, the mass was resected and found to be an antrochoanal polyp filling the entire chonae and left maxillary sinus. After surgery, her sense of smell returned, nasal congestion resolved, and she had no further infectious sinusitis episodes or polyp recurrence after four years. <h3>Discussion</h3> Pediatric nasal polyps are rare but should be considered in cases of chronic nasal congestion/obstruction. While antrochoanal polyps (arising from the maxillary sinuses) are most common in children, nasal polyps may also originate in the ethmoid/sphenoid sinuses (choanal polyps). Polyps can develop from prolonged mucosal inflammation in the setting of both eosinophilic and non-eosinophilic chronic rhinosinusitis. Lastly, pediatric nasal polyps can be associated with systemic diseases (including cystic fibrosis, primary ciliary dyskinesia, and immunodeficiency) and should prompt additional testing including sweat test and serum immunoglobulin levels.