Choanal atresia

See also Choanal atresia information

Newborns are obligate nose breathers, because the larynx (voice box) is very high in the neck. With the passing time, the larynx descends to its normal position lower down in the neck. It’s only then that they are able to breathe from the nose and mouth. Sometimes, during development the nasal passages do not open causing a condition called choanal atresia, by which the neonate develops significant respiratory distress.

It is a rare condition, occurring in approximately 1 in 8000 live births and is more common in females than in males. The blockage of the posterior choana - portion at the back of the nose - can affect either both (bilateral) nasal passages, or can limit just on one side (unilateral). The obstruction can be either completely bony (in about one-third of cases) or be composed of both bone and soft tissue.

A new born is an obligate nose breather, and hence bilateral choanal atresia is life-threatening and respiratory distress appears immediately at birth. When only one side of the nasal passage is blockedas in unilateral choanal atresia theinfant adapts to it and hence the conditionis less serious. The symptoms may be few and the patient may present them only late in childhood or sometimes even as an adult. The patient presents with one side nasal discharge with nose blockage.

There could be an association of choanal atresia with other developmental anomalies such as CHARGE, Treacher Collins syndrome and other such syndromes.

The diagnosis is made by doing a CT scan and an endoscopy.

Bilateral choanal atresia warrants an emergency surgery. As soon as the neonate is stabilized after birth, he is taken up for the correction surgery. The capital goal in the treatment is to establish a nasal passage allowing nasal breathing. Surgery is performed through the nose or the mouth. In extreme cases, the atretic plate needs to be removed using very fine burrs. The laser can be used in some cases and is a good complementary tool. Sometimes a stent (small tube) is used after surgery to keep the nasal passages open and optimally calibrate them.

Unilateral atresia is repaired at 6 -12 months.

As the newborn could have other congenital anomalies, a genetist will also evaluate them.