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    Choanal atresia

    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. It is thought to occur when the thin tissue separating the nose and mouth area during fetal development remains after birth.

    The condition is the most common nasal abnormality in newborn infants, affecting about 1 in 7,000 live births. Females get this condition about twice as often as males. More than half of affected infants also have other congenital problems.

    Choanal atresia is generally diagnosed shortly after birth while the infant is still in the hospital.

    Symptoms

    Newborns generally prefer to breathe through their nose. Typically, infants only mouth breathe when they cry. Babies with choanal atresia have difficulty breathing unless they are crying.

    Choanal atresia may affect one or both sides of the nasal airway. 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. More than half of infants have a blockage on only one side, which causes less severe problems.

    Symptoms include:

    • Chest retracts unless the child is breathing through mouth or crying
    • Difficulty breathing following birth, which may result in cyanosis (bluish discoloration), unless infant is crying
    • Inability to nurse and breathe at same time
    • 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 scan
    • 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. Surgery may be delayed if the infant can tolerate mouth breathing. The surgery may be done through the nose (transnasal) or 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
    • 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. The child may need to be checked by an ear, nose, and throat (ENT) specialist.

    Prevention

    There is no known prevention.

    References

    Haddad J Jr. Congenital disorders of the nose. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 368.

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          Review Date: 8/2/2011

          Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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