That moment your baby arrives… it’s pure magic, isn’t it? You count tiny fingers, tiny toes, and listen for that first, strong cry. But sometimes, a little worry creeps in. Maybe you notice your newborn seems to struggle for breath, especially when they’re quiet, or perhaps they turn a little bluish when not crying. It’s understandably frightening, and one possibility we doctors consider in such moments is a condition called choanal atresia.
What Exactly is Choanal Atresia?
So, what is choanal atresia (pronounced ko-UH-nul uh-TREE-zhuh)? In simple terms, it’s a birth condition – something a baby is born with – where the back of their nasal passage, the choanae, is blocked. This blockage isn’t just a bit of stuffiness; it’s usually a piece of tissue, sometimes soft, sometimes bony, or a mix of both, that didn’t open up properly during development in the womb. It can happen on one side of the nose or, less commonly but more urgently, on both.
Sometimes the passage is just narrowed, a condition we call choanal stenosis, which can also make breathing tricky. How serious it is, and how soon we need to act, really depends on how much is blocked and whether it’s one or both sides.
Types of Choanal Atresia
We generally see two main types when we’re talking about this with parents:
- Unilateral choanal atresia: This is when only one side of the nose is blocked. It’s actually the more common scenario. Because your little one can still breathe through the other nostril, the signs might not be obvious right away. I’ve seen cases where we don’t even pick up on it until a child is a bit older, or sometimes even in adulthood.
- Bilateral choanal atresia: This is when both nasal passages are blocked. Now, this is a bit more serious right from the get-go. Newborns are what we call ‘obligate nose breathers,’ meaning they naturally breathe through their noses, not their mouths (unless they’re crying, of course!). So, if both sides are blocked, it’s an emergency. We need to help them breathe immediately, often by inserting a small tube into their windpipe to secure their airway. Once they’re stable, we can plan for surgery to fix the blockage.
How Common is This Condition?
You might be wondering how often this happens. Well, choanal atresia isn’t super common, but it’s not vanishingly rare either. We see it in about 1 out of every 7,000 live births. And interestingly, it seems to affect little girls about twice as often as boys. Most of these cases, over 60%, are the unilateral type we just talked about.
Signs and Symptoms: What to Look For
When both sides are affected (bilateral choanal atresia), we, or the hospital team, usually spot the signs right after birth. Your baby might:
- Have a lot of trouble breathing unless they’re crying. It can be quite distressing to see.
- Their skin and lips might look a bit blue – we call this cyanosis. This is a clear signal they’re not getting enough oxygen. If this happens, the medical team will act very fast to help them.
If it’s just one side blocked (unilateral choanal atresia), the signs can be sneakier and might only appear after you’ve brought your baby home, or even later in childhood. You might notice:
- Your newborn’s chest seems to sink in a bit when they’re breathing quietly, but it gets better when they cry.
- Feeding can be a real struggle. Imagine trying to eat and only being able to breathe through your mouth – it’s tough for a baby trying to nurse or take a bottle. They might get very fussy or choke.
- A persistently runny or stuffy nose, but only on one side. This is a classic clue, especially if that one-sided nasal discharge just doesn’t seem to go away.
- As they get older, they might get a lot of sinus infections (what we term chronic sinusitis).
What Causes Choanal Atresia?
Parents often ask, “Why did this happen to my baby?” And honestly, for choanal atresia, we don’t have a single, exact cause. The leading thought among medical experts is that during development in the womb, the thin piece of tissue that separates the nose and mouth cavity (it’s called the bucconasal membrane) just doesn’t break down and open up as it should, usually around the sixth or seventh week of pregnancy. Why this happens in some babies and not others… well, that’s still a bit of a puzzle.
Are There Other Conditions Linked to It?
Yes, sometimes. About half the time, babies with choanal atresia are also born with other inherited syndromes or genetic disorders that cause other developmental differences. We don’t fully understand this link, but it’s something we always check for. Some conditions we sometimes see it with include:
- CHARGE syndrome (This is quite commonly associated, especially if both sides of the nose are affected. In fact, about 60% of babies with bilateral choanal atresia have CHARGE syndrome.)
- Treacher Collins syndrome
- Crouzon syndrome
- Pfeiffer syndrome
- And a few other rarer ones like Antley-Bixler, Marshall-Smith, or Schinzel-Giedion syndrome.
If we diagnose choanal atresia, we’ll also look carefully to see if any of these other conditions might be present, as it helps us make sure your baby gets the most complete and appropriate care.
What About Complications?
If choanal atresia isn’t treated, especially the unilateral kind that might go unnoticed for a while, it can lead to some longer-term issues. Think about it: if one side of the nose is constantly blocked, fluid can build up. This can sometimes lead to:
- Frequent ear infections. And over time, repeated infections can, in some cases, affect hearing. This is something we see more often if CHARGE syndrome is also part of the picture.
- Trouble getting enough air while eating can sometimes mean a risk of food or milk going down the wrong way – into the windpipe (trachea) instead of the food pipe (esophagus). We call this aspiration, and it can lead to chest infections.
This is why, even if it’s just one-sided and seems mild, we’ll want to keep a close eye on things and discuss when treatment might be best.
How We Diagnose Choanal Atresia
So, how do we figure out if it’s choanal atresia?
If we suspect it in a newborn, especially the bilateral type where breathing is difficult, we might do a simple check first. Sometimes, we try to pass a thin, soft tube (a catheter) through each nostril. If it doesn’t pass, that’s a big clue. Another old-school trick is holding a tiny mirror (like the one your dentist uses, called a laryngeal mirror) under your baby’s nose to see if their breath fogs it up on both sides.
If we need a clearer picture, we might suggest a couple of things:
- Nasal endoscopy: This sounds a bit more involved, but it’s a very useful tool. We gently slide a very thin, flexible tube with a tiny camera and light on the end (that’s the endoscope) into your baby’s nose. It lets us see directly what’s going on inside and if there’s a blockage.
- CT scan (Computed Tomography scan): This is an imaging test that gives us detailed, 3D pictures of the inside of your baby’s nose. It can clearly show us if there’s a blockage, where it is, and what it’s made of – whether it’s bone, soft tissue, or a mix.
And please know, throughout any tests, our top priority is making sure your baby is safe, comfortable, and breathing as well as possible.
Treating Choanal Atresia
When it comes to fixing choanal atresia, surgery is really the main long-term solution.
If your baby has blockages in both nasal passages (bilateral choanal atresia), they’ll likely need surgery pretty quickly to open up those airways. It’s an urgent situation.
If it’s just one side (unilateral choanal atresia) and your baby is breathing okay through the other nostril and feeding well, we might decide to wait a bit. Sometimes, babies learn to manage, breathing more through their mouth, and we can hold off on surgery until they’re a little older and bigger – perhaps even a few years old. If we go this route, we’ll talk about how to manage symptoms at home, like using saline (saltwater) drops or sprays to help keep the open nostril clear and the tissues healthy.
But eventually, most children with choanal atresia will need a surgical repair. It just helps them breathe better, eat better, sleep better, and improves their overall quality of life. The most common way we do this is with an endoscopic choanal atresia repair.
How is the Surgery Done?
The surgeon’s goal is to create an opening through that blocking tissue or bone. They can do this either through the nose (this is called a transnasal approach, and it’s the most common, especially with endoscopes) or sometimes, though less commonly these days, through the roof of the mouth (a transpalatal approach).
Sometimes, after making the opening, the surgeon might place a tiny tube, called a stent, in the nasal passage. This stent helps keep the newly made airway open while it heals and prevents it from closing up again. It’s not permanent; we usually remove it a few months later.
This surgery is done in an operating room, and your baby will be safely asleep under general anesthesia. The pediatric anesthesiologist is specially trained to care for little ones during surgery.
What to Expect: The Outlook
I know this all sounds like a lot to take in, especially when you’re a new parent or dealing with a new diagnosis for your child. If your baby is diagnosed with choanal atresia, we’ll sit down and go through everything. We’ll talk about whether it’s one-sided or two-sided, if surgery is needed right away, or if it’s safe to wait.
The good news? Treatment for choanal atresia is usually very successful. After surgery, most babies and children make a full recovery and go on to breathe much, much easier. It can really make a world of difference for them.
Living With Choanal Atresia: When to Call Your Doctor
It’s always best to trust your instincts as a parent. You know your child best. If you notice any changes in how your baby or child is breathing, if they seem to be working harder to breathe, or if they’re struggling with feedings, please don’t hesitate to give us a call. Sometimes, especially with those milder one-sided cases, the symptoms of choanal atresia can pop up later than you’d expect, or a previously managed case might need another look. It’s always better to get it checked out.
Questions to Ask Your Healthcare Provider
When you talk with us, or with a specialist like an ENT (Ear, Nose, and Throat) doctor, here are a few good questions to have in mind:
- Is the choanal atresia in one nostril or both?
- Is the blockage made of bone, soft tissue, or both?
- Could this be linked to another condition, like CHARGE syndrome?
- When do you think my child will need surgery? Is it urgent, or can we wait?
- What type of surgical approach do you recommend, and why?
- What are the risks and benefits of the surgery?
- Will a stent be used, and if so, for how long?
- How will we know the surgery has worked well, and what’s the follow-up like?
Take-Home Message: Key Points on Choanal Atresia
Here’s a quick rundown of what we’ve talked about, just to keep things clear:
- Choanal atresia is a birth defect where a baby’s nasal passage is blocked by tissue or bone, making nose breathing difficult or impossible.
- It can affect one side (unilateral) or both sides (bilateral); bilateral is more urgent and needs immediate attention.
- Symptoms can range from severe breathing difficulty and cyanosis at birth (bilateral) to one-sided stuffiness, noisy breathing, or feeding issues (unilateral).
- Diagnosis often involves a physical exam, trying to pass a catheter, nasal endoscopy, or a CT scan to see the blockage.
- Surgery is the primary treatment to open the airway, often done endoscopically, and it’s generally very successful in helping children with choanal atresia breathe freely.
- If you’re worried about your baby’s breathing or feeding, always, always reach out to your doctor.
