Choanal atresia is a congenital (present at birth) condition in which the back of the nasal passage (called the “choana”) is blocked, usually by abnormal bony or soft tissue that does not develop properly during fetal development. Normally the nasal passage forms in early development through a thick wall of soft tissue. However, in some babies, this soft tissue fails to resorb. For unknown reasons, females are born with this condition twice as often as males.
There are two main types of choanal atresia:
- Bilateral: both sides are blocked
- Unilateral: the right side is more affected than the left side
In many cases — and especially in the bilateral variant — choanal atresia is diagnosed shortly after birth, while your baby is still in the hospital. Generally, babies like to breathe through their noses at birth, unless they are crying. During feedings, they must breathe through their nose, as they nurse or drink from a bottle through their mouths. In babies with bilateral choanal atresia, breathing through their nose is difficult at rest or when feeding, causing them to turn blue and have noisy breathing.
Symptoms of bilateral choanal atresia also include:
- Aspirating milk (regurgitating milk into their lower airway)
- Noisy breathing
- Turning blue while sleeping or feeding
Feeding slowly can allow the baby to breathe between swallows. However, a feeding tube is often placed from the oral cavity into the stomach to make sure that the baby safely receives adequate feedings.
If your child has unilateral atresia, it is sometimes identified at birth, but it can go unnoticed for a few years and even into adulthood. Most commonly, children will have chronic, thick drainage from the blocked side of the nose.
Your child’s ENT specialist will perform a thorough examination of their nasal passages to inspect for the blockage.
The ENT doctor inserts a thin, flexible tube (endoscope) with a tiny camera attached to a high definition video monitor to visually inspect the inside of your child’s sinuses to properly diagnose the condition.
Your child’s doctor may order an X-ray of the sinuses to aid in diagnosis and development of a treatment plan.
Computerized Tomography (CT) Scan
Your child’s doctor may order a CT scan of the nose and sinuses to aid in diagnosis and development of a surgical treatment plan.
The immediate treatment for children with this condition is to place a breathing tube so they can breathe adequately. Most children with this condition learn to “mouth breathe” until they can undergo surgery.
Most children with choanal atresia will require surgery to remove the blockage. This can safely and effectively be performed through the nose utilizing endoscopic sinus surgery techniques.
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