Background <p>Choanal atresia is a rare congenital anomaly characterized by the blockage or narrowing of one or both posterior nasal passages (choanae), either due to membranous or bony obstruction. It occurs in approximately 1 in 7,000 to 1 in 10,000 live births. This condition can be unilateral or bilateral, with bilateral choanal atresia being more severe and typically presenting with significant symptoms early in life. Choanal atresia may lead to nasal obstruction, nasal discharge, snoring, difficulty feeding, cyanosis, and mouth breathing. It is often associated with other congenital anomalies, including craniofacial deformities and cardiac malformations.</p> Case presentation <p>This case report describes a 10-year-old male child from southern Ethiopia who was diagnosed with bilateral choanal atresia after a prolonged history of nasal obstruction and feeding difficulties. The patient underwent endonasal endoscopic choanoplasty with a successful outcome.</p> Conclusion <p>This case underscores the importance of considering choanal atresia in children presenting with chronic nasal obstruction, snoring, and feeding difficulties. Early diagnosis and surgical intervention, such as endonasal choanoplasty, can lead to significant improvements in symptoms and quality of life. Regular follow-up is essential to ensure the long-term patency of the choanal openings and to monitor for potential complications.</p>