Choanal atresia is a rare condition that affects babies.

2. Choanal atresia is a rare condition that affects babies. It is a
congenital defect that affects respiratory function and caused by
blockage of the choana, which is a passageway, that connects
each side of the nose to the throat. These passageways are
essential for breathing through the nose. This is problematic in
infants, as babies cannot breathe very easily through the nose
for at least a few months after birth.
The condition may be present as an isolated birth defect in a
baby that is otherwise healthy or it could also be part of
a genetic disorder called CHARGE syndrome that affects
various organs and bodily functions. The blockage develops as a
result of abnormal bone or tissue that obstructs the
passageways. Fortunately, choanal atresia is a rare condition,
affecting just one out of every ten thousand newborns. The
condition can affect one or both nasal passages and the blockage
may be partial or complete. There are two types of choanal
atresia Unilateral Choanal Atresia and Bilateral Choanal Atresia.

3. The causes of choanal atresia are not clearly understood but it
may have some connection with genetic factors and heredity.
The condition is caused when recanalization of the nasal fosse
does not occur during foetal development. Under normal
circumstances, there is a thin tissue membrane towards the back
of the nasal airway, which separates the nasal passages and the
mouth area in the foetus. In case of choanal atresia, this
separating tissue remains through the course of foetal
development causing a narrowing or blockage of the nasal
airways, which becomes problematic at the time of birth.
Although there are few known risk factors, there is suspicion
that both genetic and environmental triggers may be involved.

4. With regard to environmental triggers, certain studies have
validated these suspicions as in the case of an epidemiological
study in 2012 that showed a higher incidence of choanal atresia
among women living in regions where there was a high
presence of atrazine, a chemical compound used in herbicides in
the region. Other studies since then have also suggested a
similar link with second hand smoke, excessive coffee
consumption and the intake of certain anti-infective urinary
tract medications.
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5. Symptoms of choanal atresia will obviously depend on the type
of choanal atresia that is affecting the child. Unilateral choanal
atresia will only cause mild symptoms if any and the symptoms
will usually go unnoticed, as there is no immediate risk posed to
the baby. Bilateral choanal atresia on the other hand can cause
severe symptoms that can be life threatening. Symptoms of
choanal atresia include the following:
 Noisy and laboured breathing
 Difficulty feeding
 Cyclic respiratory distress which is only relieved with crying as
this allows the baby to breathe orally
 Nasal drainage
 Breathing failure upon delivery that necessitates resuscitation.
(In such a scenario, emergency surgery is necessary)

6. In many cases health care providers will arrive at their diagnosis
pretty swiftly, especially if there is difficulty inserting a nasal
catheter. Doctors will also suspect choanal atresia in the event of
cyanosis during breast feeding, as nasal respiration is essential
while feeding. If any symptoms arouse suspicion, whether life
threatening or not, health care providers will recommend certain
tests to confirm the diagnosis. A physical examination will also
suffice at times as it could reveal nasal obstruction. Tests that
can help in the diagnosis of choanal atresia include the
following:
 Sinus X-rays
 Nasal Endoscopy
 CT Scans

7. In cases where the blockage is severe, causing extreme
respiratory difficulties, emergency medical care will be
necessary. Doctors will first make efforts to resuscitate the baby
if necessary and they may need to make an airway to enable the
infant to breathe. Procedures like intubation or tracheotomy
could be required.
If the infant learns to breathe orally, surgery may not be
required as urgently and can be delayed for a while. Whether
the surgery is conducted immediately or after some delay, it can
help to cure the condition.
Treatment depends on the severity of the condition. In mild
cases where there is no significant respiratory distress or feeding
difficulty treatment could include the following:

8.  The condition may be managed by keeping the baby under close
observation and providing him with supplemental oxygen
periodically.
 To keep the nasal passages clear of discharge and prevent any
further impediments to nasal breathing, nasal saline may be
administered to keep the nasal linings healthy.
 Parents can opt to delay surgical correction of the nasal structure
until the child is older.
In severe cases, where there is a life threatening risk, usually
because of bilateral choanal atresia, there is no room for delays
in treatment. Treatment in such cases will involve evaluation of
the patient for any other anomalies. Once the patient is stable,
surgery should be performed immediately.
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9. The risk factors of choanal atresia cannot really be
avoided, as we still do not have a clear understanding
about the causes of the condition. We can do little
about genetic factors, which may contribute to the
problem. Certain environmental allergens or triggers
have also been identified as being possible risk
factors in the recent past, and in light of these
findings, it would be a good idea to avoid or reduce
exposure to the following during pregnancy:
 Atrazine, a chemical compound present in certain
herbicides
 Excessive coffee consumption
 Zinc and B-12 supplements
 Some anti-infective urinary tract medications

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