Choanal Atresia: aetiology, symptoms, signs, investigations and treatment

Definition: Choanal atresia is a congenital nasal disease where the back of nasal passage is obstructed by an abnormal soft tissue or bony tissue or even mixed, resulting from failure of recanalization of the nasal fossae during fetal development. Its incidence is relatively rare as it occurs one in every 7000 live births.

Clinical Picture (symptoms and signs):

If bilateral atresia: it’s a surgical emergency.
  • It presents with acute respiratory distress immediately after birth as newborns are obligate nasal breathers.
  • The classical picture is: cycles of respiratory distress and cyanosis which are relieved by crying (here the newborn is obliged to breathe through the mouth).
  • This is a case of acute respiratory distress. There is no role for investigations until the airway is secured.
Treatment: The goal is first directed towards securing the airway.
  • Oral airway is usually suitable to alleviate the distress as it temporarily bypasses the nasal obstruction.
  • Improvement using oral airway may aid the diagnosis of bilateral choanal atresia.
  • After securing the airway; physical examination and investigations are done.

Physical examination:

  • Absence of misting effect on putting a metal spatula or a mirror below the newborn’s external nasal aperture.
  • Inability to pass a small rubber catheter through the nose may also aid the clinical diagnosis.
  • Nasal endoscopy is cornerstone of the diagnosis. The endoscope can view the obstructed choanae.


  • CT nose and PNS is mandatory.
  • Since choanal atresia may occur alone or as part of the CHARGE syndrome, (coloboma, heart defects, atresia choanae, retardation of growth, genital anomalies and ear abnormalities), other investigations are required to exclude other systemic diseases.

Definitive treatment of Choanal atresia (surgical repair)

  • Endoscopic nasal repair is the currently the main line of treatment.
  • Trans-palatal approach is rarely used by some surgeons.

Unilateral choanal atresia

It may pass unnoticed at birth and is usually discovered later during childhood or maybe adolescence as persistent unilateral nasal obstruction and discharge with absence of history of FB insertion.

Key points

  • Choanal atresia maybe unilateral or bilateral.
  • Bilateral choanal atresia is a surgical emergency. It presents with acute respiratory distress immediately after birth. Oral airway is urgently needed to stabilize the airway. CT nose and PNS is necessary for the diagnosis. Treatment is essentially surgical using the nasal endoscope.
  • Unilateral choanal atresia may pass unnoticed at birth and maybe discovered later during childhood as unilateral persistent nasal obstruction and discharge in absence of history of FB insertion.

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