Choanal atresia

Definition

Choanal atresia is a narrowing or blockage of the nasal airway by tissue. It is a congenital condition, meaning it is present at birth.

Causes

The cause of choanal atresia is unknown, but is thought to occur when the thin tissue seperating the nasal and oral spaces during fetal development persists. The condition is the most common nasal abnormality seen in the newborn infant, affecting about 1 in 7,000 live births.

Newborns with this condition are known as an "obligate nose breathers." This means the baby must breathe through its nose because the oral airway is not yet developed enough to allow for frequent mouth breathing. In fact, almost the only time an infant does not breathe through its nose is when crying.

Choanal atresia may be affect one or both sides of the nasal airway. It is often associated with other congenital problems.

Choanal atresia blocking both sides (bilateral) of the nose causes acute breathing problems with cyanosis and breathing failure. Infants with bilateral choanal atresia may need resuscitation at delivery.

Blockage on only one side causes less severe problems. Choanal atresia is generally recognized shortly after birth while the infant is still in the hospital.

Symptoms

• Difficulty breathing following birth, which may result in cyanosis (bluish discoloration), unless infant is crying
• Inability to nurse and breathe at same time
• Chest retraction unless breathing through mouth or crying
• Inability to pass a catheter through each side of the nose into the throat
• Persistent one-sided nasal blockage or discharge

Exams and Tests

A physical examination may show an obstruction of the nose.

Tests that may be done include:

• CT
• Endoscopy of the nose
• Sinus x-ray

Treatment

The immediate concern is to resuscitate the baby if necessary. An airway may need to be placed so that the infant can breathe. In some cases, intubation or tracheostomy may be needed.

An infant can learn to mouth breathe, which can delay the need for immediate surgery.

Surgery to remove the obstruction cures the problem. It may be delayed if the infant can tolerate mouth breathing. Possible surgical approaches include through the nose (transnasal) and through the mouth (transpalatal).

Outlook (Prognosis)

Full recovery is expected.

Possible Complications

Possible complications include:

• Aspiration while feeding and attempting to breathe through the mouth
• Respiratory arrest (the infant stops breathing altogether)
• Renarrowing of the area after surgery

When to Contact a Medical Professional

Choanal atresia, especially when it affects both sides, is generally diagnosed shortly after birth while the infant is still in the hospital. One-sided atresia may not cause symptoms, and the infant may be sent home without a diagnosis. If your infant has any of the problems listed here, consult your health care provider.

Prevention

There is no known prevention.

Behrman RE. Nelson Textbook of Pediatrics. 17th ed. Philadelphia, Pa: WB Saunders; 2004.

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo; Mosby; 2005.