Partial Choanal Atresia Masking as Allergic Rhinitis

Abstract

Rhinitis is a very common condition that disrupts the quality of life of approximately 30% of the population. Rhinitis can be classified into allergic rhinitis (AR) and nonallergic rhinitis (NAR). An interesting case of NAR is presented of a 4-year-old female with a chief complaint of perennial runny nose, nasal congestion, epistaxis, and pruritis since infancy. No triggers were identified. Antihistamines and decongestants were without effect. She had a peanut foreign body in the right nostril at approximately the same time as the onset of the rhinitis. A behavioral disorder was her only other notable past medical history. Her family history was unremarkable for allergy. The notable findings on her physical examination included a normal appearing facial structure and nasal mucosa with unilateral, clear nasal discharge from the right nares. A coronal view, nonenhanced, computed tomography scan of the sinuses revealed unilateral, incomplete choanal atresia and hypoplastic turbinates on the right. The maxillary sinus was not hypoplastic and the maxilla had normal bony structure. Differentiating AR from NAR can be very difficult, as the presenting symptoms are very similar. In the pediatric population the clinician needs to be aware of the possibility of foreign body, congenital abnormalities, or systemic diseases. Having a high index of suspicion for these conditions will allow the clinician to have an in-depth differential diagnosis for the causes of rhinitis in children. (Pediatr Asthma Allergy Immunol 2000;14(2):129–135.)