Choanal Atresia - Dr. Ameet Kishore

1. Choanal Atresia - Dr. Ameet Kishore What Is ChoanalAtresia? Choanal atresia is a congenital condition. This disease is present right from birth. The patients with choanal atresia have obstructed or narrowed nasal passage that causes difficulty in breathing. It occurs due to abnormal development of the internal structure of the nose during fetal growth. If present in one nose, it results in the discharge of mucus. The presence of choanal atresia in both the nose may cause the infant shortness of breath. As the newborns cannot breathe from their mouth, the condition of obstruction of both the nasal passage is considered a medical emergency and requires immediatemanagement. What Are The Symptoms Of ChoanalAtresia? The symptoms experienced by the patient depend upon unilateral or bilateral choanal atresia. Patients experience severe symptoms in the case of bilateral choanal atresia. The patients may have acute respiratory distress. They also have cyanosis that becomes better with crying. However, the cyanosis returns at rest. Episodes of choke and progressive airway obstruction result in feeding difficulty. It is because of the inability of the infant to breathe and eatsimultaneously. The symptoms of patients with unilateral choanal atresia are less severe. They rarely experience respiratory distress conditions. However, they may have persistent discharge from the nostril of the affected side. Further, they may also have the problem of chronic sinusitis. Choanal atresia is associated with various other conditions. The most common being CHARGE syndrome that may cause ear problems, genital disease, heart disease, and mental retardation. What Are The Types Of ChoanalAtresia? Depending upon the single or both nasal pathways involved, there are two types of choanal atresia. These are:

2. Unilateral choanal atresia: It is a more common type of choanal atresia than bilateral choanal atresia. In this condition, there is a blockage on one side of the nose. The nose block is usually on the right side. The infant compensates for the obstruction by breathing from the open nostril. Bilateral choanal atresia: It is characterized by blockage in both the nostril. It is a dangerous situation as babies do not breathe from their mouths. It may result incyanosis. Both types of choanal atresia are further divided into the followingtypes: Bone and soft tissue blockage: The blockage is formed of bones and soft tissues. It occurs in almost 70% of cases of choanalatresia. Bone blockage: In this type, the blockage is made up of only the bones. It constitutes around 30% of thecases. What Is The Prevalence Of ChoanalAtresia? The incidence of choanal atresia is around 1 in 5000 to 1 in 8000 live births. It is twice as common in females as males. Unilateral is more common than bilateral with a ratio of incidence of about3:2. What Are The Causes Of ChoanalAtresia? The exact cause of choanal atresia remains unknown. However, researchers believe that it is a combination of environmental and genetic factors. It has been found that mothers who took thyroid drugs have a higher incidence of choanal atresia in their babies. However, it is not clear whether this increased risk is due to the thyroid disease itself or the thyroiddrugs. Several other conditions occur along with the choanal atresia. These conditions are CHARGE syndrome, Treacher Collins syndrome, Crouzon syndrome, Tessier syndrome, Coloboma, and Genital hypoplasia.

3. How Doctor Diagnoses ChoanalAtresia? The doctor diagnoses bilateral choanal atresia soon after the birth due to difficulty breathing in the infant. The doctor then performs a further examination to rule out the presence of other causes of nasal obstruction. The doctor inserts the thin plastic tube from the nostril to the pharynx. If the blockage is present, it may not pass throughit. The doctor may also perform the imaging tests such as CT scans and MRIs. This test may help the doctor to rule out the other causes of nasal obstruction. Further, with the help of imaging techniques, the doctor may also determine the anatomy and thickness of the bonyplate. What Are The Treatments For ChoanalAtresia? Treatment depends upon the severity of the condition and symptoms of the infant. Usually, the patients with unilateral choanal atresia do not require treatment and are under frequent monitoring of theclinicians. However, it is necessary to keep their open nose clear. For this, the doctor may prescribe a salinesolution. Surgery is the only option in patients with bilateral choanal atresia. The doctor performs the surgery as soon as possible. The patient is kept on nasal tube breathing until surgery. The surgery may be through endoscopy or open procedure depending upon thecondition. What Is The Outlook Of ChoanalAtresia? Babies with unilateral choanal atresia do not have any problem most of their life. During surgery in bilateral choanal atresia, the surgeons remove the tissues that obstruct the passage. Thus, after surgery, the patient leads a healthylife.