Bilateral in an infant
The baby turns blue and suffocates at rest, and turns pink when crying and breathing through the mouth.
CONDITION / CARRY
Choanal atresia.
Choanal atresia is a congenital defect in which the posterior openings of the nose are closed by a bony or soft membrane and air does not pass into the nasopharynx. Bilateral needs help immediately after birth, unilateral is often detected later.
CONCEPTUAL VISUALIZATION- what is it
- Congenital closure of the posterior openings of the nose (choan) with a bony or mixed membrane.
- How often
- Approximately 1 in 5,000–8,000 newborns; twice as often in girls.
- When operating
- Bilateral - in the first days of life. Unilateral — planned, in children preferably after 6 months.
- Who treats
- ENT surgeon; today mostly endoscopically, through the nose.
01 / WHAT IS ITWhat is
What is
choanal atresia.
The choanae are the two posterior openings of the nose through which air passes from the nasal passages into the nasopharynx. With atresia, one or both openings are closed by a membrane that did not dissolve during intrauterine development.
Newborns breathe mainly through their nose in the first weeks, so bilateral atresia is an urgent condition: the child is immediately provided with mouth breathing and prepared for surgery. Unilateral atresia is sometimes noticed only in old age or even in adults.
In almost 75% of patients, choanal atresia is combined with other defects of the face and skull or syndromes, most often with CHARGE. Therefore, the child is examined more widely than just the nose.
This is general information. The doctor draws up a treatment plan after endoscopy and CT scan.
02 / SIGNSHow
How
atresia manifests itself.
Manifestations depend on whether both choanae are closed or one.
Feeding difficulties
During sucking, the child cannot breathe and often breaks away from the breast or bottle.
One-sided obstruction
One half of the nose does not breathe from birth, drops do not help.
Allocation from one side
Thick mucus constantly accumulates in the closed half of the nose.
03 / REASONSWhy does this
Why does this
happen.
Atresia is a developmental defect, not a consequence of disease or care. According to the Texas Registry of Malformations, the incidence of choanal atresia or stenosis was 0.92 per 10,000 live births.
Fetal development
The membrane between the nose and the oral cavity does not dissolve in the early weeks of pregnancy.
Syndromes
It is often accompanied by CHARGE syndrome: in a cohort of 114 operated on, it was present in 17.5%, other defects in some children.
gender
Girls have choanal atresia twice as often as boys.
04 / SEEK MEDICAL ADVICE
When do you need help?
Bilateral atresia in a newborn is an emergency condition: without mouth breathing, the child does not get enough air.
103 immediately if:
- the newborn turns blue or suffocates, and turns pink when crying;
- the child cannot breathe during feeding.
See an ENT doctor in the coming days if:
In a child or an adult, one half of the nose does not breathe from birth and thick mucus constantly flows from it. Such unilateral atresia is examined and treated as planned.
05 / DIAGNOSTICSHow the
How the
diagnosis is made.
- Passability check
In the maternity ward, an attempt is made to pass a thin catheter through the nose into the pharynx.
- Nasal endoscopy
The doctor sees a membrane at the site of the choana.
- CT
It shows the thickness and composition of the membrane - is it bony or mixed - and the structure of the nasal cavity.
- Examination of the child
Search for accompanying defects: heart, eyes, ears, because atresia is often included in the syndromes.
06 / TREATMENTHow to treat
How to treat
choanal atresia.
There are no randomized studies that would prove the superiority of one method. Most surgeons today choose endoscopic surgery through the nose.
01
Operation
- Endoscopic access
- The membrane is removed through the nostrils under camera control and a new opening is formed. Access through the palate is reserved for cases when the nasal passage is too narrow for instruments.
- Flaps of mucosa
- The wound in the new choana is covered with flaps of own mucosa. In a review of 266 patients without stents, the operation was successful in 89%, re-operation was required in 11%.
- Stents
- The tubes that keep the hole open are used with increasing caution: in one study, strictures occurred even more often with them.
02
When to operate
- Bilateral atresia
- They operate immediately. In a review of 23 studies (362 patients), with bilateral atresia and immediate surgery, primary failure was 24.8%, with delayed failure - 42.6%.
- Unilateral atresia
- If possible, the operation is postponed until the age is more than 6 months and the weight is more than 5 kg - this reduces the risk of failure.
03
After surgery
- Re-narrowing
- The most common complication is restenosis: according to reviews, it requires repeated surgery in many patients, more often with a bilateral form.
- Observation
- Rinsing of the nose with saline solutions and control by an ENT doctor at least one year after the operation.
07 / AT THE VALIKHNOVSKY CLINIC
How do we
How do we
treat it.
Choanal atresia is operated on at Dr. Valikhnovsky's Institute of Surgery in the "New Nose" direction - endoscopically, through the nose.
DIRECTION TO THE CLINIC
A new nose
Shape, support and breathing of the nose: septum, concha, sinuses, consequences of injuries, failed operations and removal of tumors.
Go to direction
What do we do in this condition
- Endoscopic correction of choanal atresia — removal of the membrane and formation of a new choana through the nostrils.
- Endoscopic interventions on the septum — if the shape of the nasal passage needs to be corrected together with the choana.
Rostislav Valikhnovsky
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.
How is the treatment in us
- ConsultationConversation, examination and endoscopy of the nose.
- CTEvaluation of the membrane and structure of the nose; for children - together with a pediatric examination.
- PlanWhen and how to operate, whether stents or flaps are needed.
- OperationEndoscopic correction through the nose.
- ControlCheck-ups at least once a year to detect narrowing in time.
08 / QUESTIONS AND ANSWERSFrequently asked
Frequently asked
questions.
Short answers. What is right for you, the doctor will tell you during the consultation.
Can choanal atresia go away on its own?
No. The membrane is removed only surgically; without surgery, unilateral atresia remains for life, although it is sometimes only observed in mild manifestations.
At what age is unilateral atresia operated on?
If breathing allows, after 6 months and weight over 5 kg: in a cohort of 114 patients, younger age and weight increased the risk of failure. Adults are operated on at any age.
Can atresia be detected in adulthood?
Yes, one-sided - often. A person lives for years with one half of the nose, which does not breathe, and constant secretions from it.
How often is reoperation required?
Re-narrowing is the most common complication, especially with bilateral atresia. In a review of 266 patients treated with mucosal flaps, 11% required reoperation.
Why is a child with atresia examined more widely?
In almost 75% of patients, choanal atresia is combined with other facial and cranial defects or syndromes, in particular CHARGE. Therefore, the heart, eyes and hearing are also checked.
Are tubes in the nose necessary after surgery?
Not always. Stents are now placed selectively: in one study, they did not reduce but increased the frequency of strictures. The decision is made by the surgeon.
Sources
10 sources · reviews, guidelines and studiesShowCollapse
- Surgery for congenital choanal atresiaCochrane Database of Systematic Reviews, 2012doi:10.1002/14651858.CD008993.pub2 ↗
- Neonatal Choanal Atresia and StenosisNeoReviews, 2025doi:10.1542/neo.26-6-022 ↗
- Prevalence and descriptive epidemiology of choanal atresia and stenosis in Texas, 1999-2018American Journal of Medical Genetics Part A, 2024doi:10.1002/ajmg.a.63549 ↗
- Choanal atresia: a review of contemporary treatment strategiesCurrent Opinion in Otolaryngology & Head and Neck Surgery, 2024doi:10.1097/MOO.0000000000001006 ↗
- Immediate versus delayed surgery in congenital choanal atresia: A systematic reviewInternational Journal of Pediatric Otorhinolaryngology, 2019doi:10.1016/j.ijporl.2019.01.001 ↗
- Prognostic Factors and Management of Patients with Choanal AtresiaJournal of Pediatrics, 2019doi:10.1016/j.jpeds.2018.08.074 ↗
- Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic reviewActa Otorrinolaringológica Española, 2021doi:10.1016/j.otorri.2020.01.002 ↗
- Bilateral Choanal Atresia and Endoscopic Surgery: A Chance for CHARGE PatientsJournal of Clinical Medicine, 2021doi:10.3390/jcm10132951 ↗
- Choanal atresia surgery: outcomes in 42 patients over 20 years and a review of the literatureEuropean Archives of Oto-Rhino-Laryngology, 2021doi:10.1007/s00405-020-06506-6 ↗
- Choanal Atresia Repair With Stents and Flaps: A Systematic Review ArticleAllergy & Rhinology, 2021doi:10.1177/21526567211058052 ↗
The figures on the page are from these sources.
One half
of the nose does not breathe?
Please describe from what age this has been going on, or send a CT scan. The doctor will tell if it looks like atresia and how to treat it.