Learn About Choanal Atresia

What is the definition of 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.

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What are the causes of Choanal Atresia?

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. Females get this condition about twice as often as males. More than half of affected infants also have other congenital problems.

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

What are the symptoms of Choanal Atresia?

Newborns generally prefer to breathe through their nose. Typically, infants only breathe through their mouths 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 of the nose causes acute breathing problems with bluish discoloration and breathing failure. Such infants may need resuscitation at delivery. More than one 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.
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What are the current treatments for Choanal Atresia?

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 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).

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What is the outlook (prognosis) for Choanal Atresia?

Full recovery is expected.

What are the possible complications of Choanal Atresia?

Possible complications include:

  • Aspiration while feeding and attempting to breathe through the mouth
  • Respiratory arrest
  • Renarrowing of the area after surgery
When should I contact a medical professional for Choanal Atresia?

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.

How do I prevent Choanal Atresia?

There is no known prevention.

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What are the Latest Advances for Choanal Atresia?
Endoscopic Endonasal Repair of Congenital Choanal Atresia: Predictive Factors of Surgical Stability and Healing Outcomes.
Summary: Endoscopic Endonasal Repair of Congenital Choanal Atresia: Predictive Factors of Surgical Stability and Healing Outcomes.
Long Term Incidence and Outcomes of Sinonasal and Otologic Disease in Patients With Pyriform Aperture Stenosis and Choanal Atresia.
Summary: Long Term Incidence and Outcomes of Sinonasal and Otologic Disease in Patients With Pyriform Aperture Stenosis and Choanal Atresia.
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Congenital bilateral choanal atresia: an endoscopic approach with multi-flaps supported by neuronavigated CT.
Summary: Congenital bilateral choanal atresia: an endoscopic approach with multi-flaps supported by neuronavigated CT.
Who are the sources who wrote this article ?

Published Date: August 31, 2021
Published By: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Elluru RG. Congenital and acquired malformations of the nose and nasopharynx. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 190.

Haddad J, Dodhia SN. Congenital disorders of the nose. In: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 404.

Otteson TD, Wang T. Upper airway lesions in the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 68.