What is Choanal Atresia?
Choanal atresia is a congenital condition characterized by the blockage of the posterior nasal airway, either by bone or soft tissue. This blockage can be unilateral (affecting one nostril) or bilateral (affecting both nostrils). It is a critical condition in neonates because newborns are obligate nasal breathers for the first few months of life, meaning they rely heavily on their nasal passages for breathing.
How Common is Choanal Atresia?
The incidence of choanal atresia is estimated to be about 1 in 7,000 live births. It is slightly more common in females than in males. Bilateral choanal atresia is less common but more critical due to its immediate impact on the infant's ability to breathe.
What are the Symptoms?
The clinical presentation of choanal atresia varies based on whether the condition is unilateral or bilateral. In cases of
bilateral choanal atresia, symptoms are usually apparent immediately after birth and can include difficulty breathing, cyanosis (bluish coloration of the skin), and episodes of apnea (temporary cessation of breathing). In unilateral cases, symptoms may be more subtle and include chronic nasal discharge, difficulty feeding, and persistent nasal obstruction.
How is it Diagnosed?
Diagnosis of choanal atresia typically involves a combination of clinical examination and imaging studies. In a physical exam, the inability to pass a catheter through the nasal passage can be a strong indicator.
Imaging techniques such as nasal endoscopy, computed tomography (CT) scans, or magnetic resonance imaging (MRI) can confirm the diagnosis and help delineate the extent and nature of the blockage.
What are the Treatment Options?
Treatment for choanal atresia is primarily surgical. The surgical approach depends on the severity and type of atresia. For bilateral cases, immediate intervention is often required to establish an airway. This may involve the use of oral airways, intubation, or surgical creation of a passage through the obstruction. In less urgent cases or unilateral atresia, surgery can be planned to remove the bony or membranous tissue causing the blockage. Post-operatively, stents may be placed to prevent re-closure, and follow-up care is crucial to monitor for complications.
Are There Associated Conditions?
Choanal atresia can be an isolated anomaly, but it is frequently associated with other congenital conditions. One well-known association is with
CHARGE syndrome, a complex condition that includes Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and development, Genital abnormalities, and Ear abnormalities. Therefore, a thorough evaluation for other anomalies is recommended when choanal atresia is diagnosed.
What is the Prognosis?
The prognosis for infants with choanal atresia largely depends on the presence of other associated anomalies and the success of surgical intervention. Isolated choanal atresia, when treated effectively, generally has a good prognosis, and most children can go on to lead normal lives. However, those with associated syndromes or complications may have a more guarded prognosis and require ongoing medical care.
Conclusion
Choanal atresia is a significant neonatal disorder that requires prompt diagnosis and intervention, especially in bilateral cases. Understanding the symptoms, diagnostic methods, and treatment options is crucial for managing this condition effectively. Multidisciplinary care involving neonatologists, otolaryngologists, and other specialists is often necessary to address the complexities of this congenital anomaly and any associated conditions.
