Rishi Desai, MD, MPH

Choanal atresia

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NOTES NOTES  UPPER RESPIRATORY TRACT CONGENITAL MALFORMATIONS  CHOANAL ATRESIA osms.it/choanal-atresia PATHOLOGY & CAUSES ▪ Congenital narrowing or blockage of the nasal passage (choana) by abnormal bony or soft tissue ▪ Most common nasal abnormality in newborns; more than 50% have other congenital conditions ▪ ⅔ present unilaterally, ⅓ bilaterally ▪ Cause unknown: can be associated with conditions that cause depression of the nasal bridge or midface retraction (craniosynostosis syndromes)  MNEMONIC  In context of CHARGE association Coloboma Heart defects Atresia of choanae Retardation (physical, mental) Genitourinary abnormalities Ear defects  RISK FACTORS  ▪ Possible association with: low thyroid hormone levels; smoking; coffee consumption; high maternal zinc and B12 intake; exposure to agricultural chemicals; anti-infective urinary tract medications  COMPLICATIONS  ▪ Aspiration while feeding ▪ Respiratory arrest  956 OSMOSIS.ORG  ▪ Re-narrowing of the area after surgery  SIGNS & SYMPTOMS ▪ Variance of presentation depends on unilateral or bilateral defect ▪ Newborns are obligate nasal breathers → difﬁculty breathing unless crying ▪ Unilateral choanal atresia may not be detected for years → newborn uses healthy nostril to breathe; distress may be intermittent ▪ Bilateral choanal atresia can be lifethreatening; causes acute breathing problems and cyanosis ▪ Marked chest retraction ▪ Inability to nurse and breathe at the same time ▪ Persistent one-sided mucous discharge ▪ Cyanosis  DIAGNOSIS DIAGNOSTIC IMAGING CT scan Endoscopy of the nose Sinus radiography  OTHER DIAGNOSTICS  ▪ Inability to pass a catheter through nasal passage   

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