Choanal Atresia in Children

Overview

Choanal atresia is a congenital condition in which the back of the nasal passage (choana) is blocked by bone or soft tissue, preventing normal airflow from the nose to the throat. This blockage can affect one or both sides of the nose, leading to breathing difficulties, especially in newborns. Babies typically breathe through their noses, and choanal atresia can cause significant respiratory distress, particularly during feeding or sleep. Early diagnosis and treatment are crucial to ensure that the child can breathe properly and avoid complications.

Symptoms

The symptoms of choanal atresia can vary depending on whether one or both sides of the nasal passage are blocked. Common symptoms include:

  • Difficulty breathing through the nose: Babies may struggle to breathe normally, especially when feeding or sleeping. 
  • Cyanosis (bluish skin): A lack of oxygen can cause the baby’s skin, particularly around the mouth, to turn blue, which may improve when the baby cries (since they breathe through their mouth when crying).
  • Difficulty feeding: Babies with choanal atresia may have trouble feeding because they cannot breathe easily while suckling.
  • Choking or gagging: Feeding difficulties can lead to frequent choking or gagging.
  • Nasal discharge: Persistent nasal discharge or mucus buildup, especially on one side if only one nasal passage is affected.
  • Snorting or noisy breathing: Babies may make snorting, noisy, or whistling sounds when trying to breathe.

Causes

Choanal atresia occurs during fetal development when the nasal passages fail to fully open, leaving a bony or membranous blockage. The exact cause of this developmental anomaly is not well understood, but it is a congenital condition present at birth. In some cases, choanal atresia may be associated with other congenital syndromes, such as:

  • CHARGE syndrome: A genetic condition that can cause multiple birth defects, including choanal atresia, heart defects, and ear abnormalities.
  • Craniofacial abnormalities: Children with certain craniofacial conditions may be more prone to choanal atresia.

Types of Choanal Atresia:
There are two main types of choanal atresia:

  • Unilateral choanal atresia: One side of the nasal passage is blocked. This type may not be detected until later in childhood, as babies can still breathe through the other side.
  • Bilateral choanal atresia: Both sides of the nasal passage are blocked, causing more severe symptoms and often requiring immediate intervention after birth.

Risk Factors

While the exact cause of choanal atresia is not well understood, certain factors may increase the likelihood of the condition:

  • Family history: In rare cases, choanal atresia may run in families.
  • Syndromes: Babies born with certain genetic syndromes, such as CHARGE syndrome, are at a higher risk for choanal atresia.

Diagnosis

Choanal atresia is often diagnosed shortly after birth, especially in cases where both sides of the nasal passage are blocked and the baby has difficulty breathing. The diagnostic process may include:

  • Medical history: The doctor will ask about the baby’s symptoms, such as breathing difficulties, cyanosis, and feeding issues.
  • Physical examination: The doctor will examine the baby’s nose and mouth. A small tube or catheter may be gently passed through the baby’s nostrils to check for blockages.
  • Nasal endoscopy: A nasal endoscopy, in which a small camera is inserted into the nose, may be used to directly visualize the nasal passage and identify the blockage.
  • CT scan: In some cases, a CT scan may be performed to provide detailed images of the nasal passage and confirm the diagnosis.

Treatment Options

The treatment for choanal atresia depends on the severity of the blockage and whether one or both sides of the nasal passage are affected. At Gertrude’s Children’s Hospital, we provide expert care for children with choanal atresia, ensuring that they can breathe comfortably and safely.

    • Immediate airway management:
      In newborns with bilateral choanal atresia, immediate intervention is often required to ensure the baby can breathe. Temporary measures, such as using an oral airway or placing a breathing tube, may be necessary until definitive treatment can be performed.
  • Surgical repair:
    Surgery is the main treatment for choanal atresia. The goal of surgery is to remove the blockage and create an open airway. 
    • Treatment for choanal atresia (a condition where the nasal passages are blocked) is divided into emergency and planned procedures:
      • Emergency Treatment:
        • Bilateral choanal atresia in newborns is an emergency. The baby can’t breathe through their nose, so an oral airway (a small tube placed in the mouth) is inserted to help them breathe. This can be used for a few weeks until a more permanent treatment is done.
        • Other temporary options include using a McGovern nipple or intubation (a breathing tube).
      • Surgical Repair Options:
        • The goal of surgery is to open up the blocked nasal passage while minimizing harm to the baby’s facial structures. There is no one perfect surgical method, but each aims to ensure safe breathing and a short recovery time.
          • Transnasal puncture: This method involves creating an opening through the nose but has become less popular due to a high failure rate and the need for repeat surgery.
          • Transpalatal repair: Involves going through the roof of the mouth (palate). This method provides good visibility but can lead to more complications, such as increased blood loss, palate issues, and possible effects on facial growth.
          • Endoscopic approach: This newer method uses a small camera (endoscope) to help the surgeon see inside the nose. It offers better visibility and allows for more precise removal of the bone that is blocking the airway. This technique is less invasive and generally leads to a shorter hospital stay.
          • Laser techniques: Some surgeries use carbon dioxide or KTP lasers to remove the blockage. These lasers work quickly, cause minimal discomfort, and often don’t require a stent (a tube to keep the airway open) afterward.
          • Mitomycin C: Sometimes, a medication called mitomycin C is applied during surgery to prevent scar tissue from forming, reducing the need for further procedures or stents.
  • Surgical Success:
    • Studies show high success rates with endoscopic nasal surgery, especially for unilateral (one-sided) choanal atresia (96.3% success) and bilateral (both sides) cases (86.2%).

Each method has its advantages and potential risks, and your doctor will choose the best option based on your child’s specific case.

  • Postoperative care:
    After surgery, the baby will be closely monitored to ensure that the airway remains open and that there are no complications. Nasal saline drops and suctioning may be recommended to keep the nasal passages clear of mucus and promote healing.

Choanal Atresia in Children

Yes, choanal atresia can be effectively treated with surgery to open the nasal passages. Most children go on to have normal breathing and development after surgery.

In cases of bilateral choanal atresia, surgery may be performed soon after birth, once the baby is stable. For unilateral choanal atresia, surgery can sometimes be delayed if the child is breathing well through the other nostril.

In some cases, additional surgeries may be needed if the nasal passage narrows again after the initial procedure. Follow-up visits are important to monitor your child’s progress.

Most babies recover within a few weeks after surgery. They may require nasal stents for a short period, and follow-up visits with the ENT specialist will ensure proper healing.

Without treatment, choanal atresia can lead to breathing difficulties, feeding problems, and recurrent respiratory infections. In severe cases, untreated choanal atresia can be life-threatening. Early diagnosis and treatment are essential.

Contact Us

If your child has been diagnosed with choanal atresia, Gertrude’s Children’s Hospital is here to provide expert care. Our pediatric ENT specialists will work with you to ensure that your child can breathe comfortably and safely.

Contact us today to learn more about our Choanal Atresia in Children treatment options.

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