Bilateral antrochoanal polyp: a case report of an extremely rare entity managed conservatively with a review from the past 26 years

Antrochoanal polyp (ACP) is a well-known benign sinonasal polyp first described in the early 20th century. ACP mostly presents as a unilateral mass and is treated solely with surgical excision. CASE PRESENTATION: We report a rare case of a middle-aged man presenting with nasal obstruction, rhinorrhea, and sleeping disturbances, eventually diagnosed with bilateral ACPs. After confirming the diagnosis with imaging and biopsy studies, the patient was treated conservatively, with marked improvements in his symptoms during 2–3 months of regular follow-ups. A review of the relevant literature regarding the presentation, diagnosis, and outcome of this rare entity is presented, highlighting its controversial etiopathogenesis. CLINICAL DISCUSSION: Presenting symptoms of ACP in most cases is unilateral progressive nasal obstruction. The occurrence of ACP bilaterally is rarely encountered in clinical practice. Diagnosis is mainly clinical and is achievable via nasal endoscopic examination and supported by computed tomography imaging. Treatment remains to be surgical, with 2 years of regular follow-ups being advised to detect any recurrence. CONCLUSION: This case report adds to the scarce data pool on bilateral ACPs and highlights the necessity of prudent and timely diagnosis of this uncommon entity to avoid unnecessary investigations and lengthy medical or surgical treatment. Additionally, a trial of medical therapy may provide symptomatic relief for patients who do not qualify for surgery.