Choanal Atresia – Symptoms, Diagnosis, and Treatment

Choanal atresia is a rare but serious nasal condition that affects breathing, especially in newborns. It occurs when the back of the nasal passage (the choana) is blocked by abnormal bone or tissue, preventing proper airflow from the nose to the throat. This blockage can occur on one side (unilateral) or both sides (bilateral).

Bilateral choanal atresia is a medical emergency in newborns, as they breathe primarily through their nose. Immediate intervention is required to ensure adequate oxygen supply. In older children or adults, the condition may present with chronic nasal blockage, difficulty breathing, or recurrent sinus infections.

Dr. L K Gupta, MBBS, DLO, MAOI, Gold Medalist, provides accurate diagnosis and expert surgical treatment for choanal atresia, ensuring improved breathing and overall health.

Understanding Choanal Atresia

The choana is the passageway that connects the nasal cavity to the nasopharynx (the area behind the nose and above the throat). In choanal atresia, this passage is blocked by:

• Bony Tissue: Most common type, caused by abnormal bone formation during fetal development.

• Membranous Tissue: Caused by an abnormal layer of soft tissue.

• Mixed Type: Combination of both bone and membrane blockage.

Causes and Risk Factors

Choanal atresia is typically a congenital condition, meaning it develops before birth. The exact cause is not always known, but factors that may contribute include:

• Developmental abnormalities during fetal growth

• Genetic syndromes such as CHARGE syndrome

• Chromosomal abnormalities

• Environmental influences during pregnancy

It is more common in females and may occur alone or as part of other birth defects.

Types of Choanal Atresia

1. Unilateral Choanal Atresia

   • Affects one nostril

   • May go unnoticed until later in childhood

   • Symptoms include one-sided nasal blockage and discharge

2. Bilateral Choanal Atresia

   • Affects both nostrils

   • Life-threatening in newborns as they cannot breathe properly through the mouth initially

   • Requires emergency intervention

Signs and Symptoms

The symptoms of choanal atresia vary depending on whether the condition is unilateral or bilateral.

In Newborns (Bilateral)

• Difficulty breathing, especially during feeding

• Cyanosis (bluish skin due to lack of oxygen) that improves when crying

• Noisy breathing

• Restlessness and irritability

In Older Children or Adults (Unilateral)

• Persistent one-sided nasal blockage

• Chronic nasal discharge

• Recurrent sinus infections

• Difficulty breathing through the affected nostril

• Snoring or noisy breathing during sleep

Complications if Untreated

If choanal atresia is not treated promptly, it can cause:

• Severe breathing difficulties in newborns

• Oxygen deprivation, leading to brain damage or death in bilateral cases

• Chronic sinusitis and nasal infections

• Mouth breathing habits leading to dental and facial growth issues

• Poor feeding and weight gain in infants

Diagnosis of Choanal Atresia

Dr. L K Gupta follows a precise diagnostic approach to confirm choanal atresia:

1. Clinical Examination – Assessing breathing patterns and nasal airflow.

2. Passing a Nasogastric Tube – In newborns, inability to pass a thin tube through the nostril into the throat can indicate blockage.

3. Nasal Endoscopy – Direct visualization of the nasal passages using a small camera.

4. Imaging Studies – CT scan to determine the exact location, type (bony, membranous, or mixed), and extent of blockage.

Treatment Options for Choanal Atresia

Treatment depends on the severity, type, and age of the patient.

Emergency Management (Bilateral Cases in Newborns)

• Immediate securing of the airway using an oral airway device or intubation.

• Temporary relief until surgery can be performed.

Definitive Surgical Treatment

Dr. L K Gupta uses advanced surgical techniques to open the blocked passage and restore normal breathing. The main approaches include:

1. Transnasal Endoscopic Surgery

   • Minimally invasive method using an endoscope.

   • The blocked tissue or bone is removed, and the airway is reconstructed.

   • Faster recovery and minimal scarring.

2. Transpalatal Surgery

   • Access through the roof of the mouth.

   • Used in complex or recurrent cases.

Post-Surgical Care

• Nasal stenting may be used temporarily to keep the airway open.

• Regular nasal saline irrigation to prevent crusting and blockage.

• Follow-up endoscopic checks to monitor healing and prevent recurrence.

Recovery and Prognosis

• In newborns with bilateral choanal atresia, surgery can be lifesaving.

• Children and adults with unilateral choanal atresia often experience complete relief after treatment.

• Long-term prognosis is excellent with proper surgical correction and follow-up care.

Prevention and Parental Guidance

Since choanal atresia is usually a congenital condition, prevention is not possible. However:

• Early screening of newborns for nasal breathing difficulties is crucial.

• Parents should seek immediate medical attention if their baby shows signs of distress during feeding.

• In older children, persistent nasal blockage on one side should not be ignored.

Why Choose Dr. L K Gupta for Choanal Atresia Treatment?

• Highly Qualified: MBBS, DLO, MAOI, Gold Medalist with extensive ENT expertise.

• Advanced Facilities: Equipped with modern diagnostic and surgical tools.

• Emergency Handling: Skilled in managing critical newborn airway cases.

• Minimally Invasive Surgery: Focus on faster recovery and less discomfort.

• Comprehensive Aftercare: From surgery to follow-up, every step is carefully managed.

Conclusion

Choanal atresia, though rare, is a serious condition that can severely affect breathing and overall health if not treated promptly. Bilateral cases in newborns require emergency intervention, while unilateral cases can cause chronic nasal problems if left untreated.

With expert evaluation, precise surgical skills, and patient-centered care, Dr. L K Gupta provides effective treatment for choanal atresia, ensuring restored breathing and improved quality of life for patients of all ages.