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Choanal Atresia: Causes, Symptoms & Treatment

Choanal atresia is a congenital malformation in which the posterior nasal passages are blocked, preventing airflow from the nose to the throat. It can affect one or both sides and requires immediate treatment when bilateral.

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Things worth knowing about "Choanal atresia"

Choanal atresia is a congenital malformation in which the posterior nasal passages are blocked, preventing airflow from the nose to the throat. It can affect one or both sides and requires immediate treatment when bilateral.

What is Choanal Atresia?

Choanal atresia is a congenital condition in which the choanae – the openings at the back of the nasal passages leading into the throat – are completely or partially blocked by a membrane or bony wall. This obstruction prevents normal airflow through the nose. Choanal atresia is one of the most common congenital nasal anomalies, occurring in approximately 1 in 5,000 to 8,000 newborns. It is more common in females than males.

Causes

The exact cause of choanal atresia is not fully understood. During embryonic development, a thin tissue membrane or bony plate that normally dissolves fails to do so, leaving the posterior nasal openings blocked. Possible contributing factors include:

Genetic and chromosomal abnormalities (e.g., CHARGE syndrome)
Disruptions in early embryonic development
Exposure to certain medications or environmental toxins during pregnancy

Choanal atresia frequently occurs as part of a syndrome. The most common associated condition is CHARGE syndrome (Coloboma, Heart defects, Atresia of the choanae, Retardation of growth, Genital abnormalities, Ear anomalies).

Types of Choanal Atresia

Unilateral Choanal Atresia

Only one side of the nasal passage is blocked. Symptoms are generally milder, and the condition may not be diagnosed until childhood or even adulthood, as the unaffected side allows for adequate breathing.

Bilateral Choanal Atresia

Both nasal passages are blocked. Because newborns are obligate nasal breathers in the first weeks of life, bilateral choanal atresia represents a medical emergency that requires immediate intervention after birth.

Symptoms

Symptoms depend on whether one or both sides are affected:

Bilateral choanal atresia: Severe respiratory distress immediately after birth, cyanosis (bluish skin discoloration), symptoms that improve when the baby cries (as crying forces mouth breathing), difficulty feeding, risk of suffocation
Unilateral choanal atresia: Persistent one-sided nasal discharge, thick mucus from one nostril, less severe breathing difficulties

Diagnosis

Diagnosis is typically made shortly after birth. The following methods are used:

Nasal passage test: Attempting to pass a thin suction catheter through each nostril – failure to pass indicates obstruction
Endoscopy: Direct visualization of the choanae using a flexible or rigid nasal endoscope
Computed tomography (CT scan): Imaging to assess the nature of the obstruction (membranous or bony) and to plan surgery
Prenatal diagnosis: In some cases, the anomaly may be detected during prenatal ultrasound

Treatment

The treatment of choanal atresia is surgical. The goal is to open the blocked nasal passages and restore normal nasal breathing.

Immediate Measures

In cases of bilateral choanal atresia, an oral airway (Guedel airway) or endotracheal intubation must be established immediately after birth to secure the airway.

Surgical Correction

The standard surgical approach is transnasal endoscopic repair, in which the obstructing tissue or bone is removed under direct visualization through the nose. In some cases, a transpalatal approach (through the palate) may be necessary. After surgery, stents (thin plastic tubes) are often placed in the nasal passages to prevent re-closure during healing.

Follow-up Care

Regular endoscopic follow-up is essential after surgery, as restenosis (re-narrowing of the nasal passage) occurs in a significant proportion of cases and may require revision surgery.

Prognosis

With early diagnosis and timely surgical treatment, the overall prognosis for choanal atresia is good. Children without additional malformations or syndromes typically develop normally after successful repair. When choanal atresia occurs as part of a syndrome, the prognosis is largely determined by the associated conditions.

References

Hengerer AS, Strome M. Choanal atresia: a new embryologic theory and its influence on surgical management. Laryngoscope. 1982;92(8):913-921.
Koltai PJ, Nelson M, Castellon RJ, et al. The natural history of congenital choanal atresia. Archives of Otolaryngology Head and Neck Surgery. 2002;128(7):804-809.
World Health Organization (WHO). Congenital anomalies fact sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/congenital-anomalies

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