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How to manage choanal atresia in children

How to manage choanal atresia in children

Choanal atresia is a congenital condition where the nose and throat are not connected properly
choanal atresia, bilateral choanal atresia, choanal atresia symptoms, choanal atresia repair, choanal atresia treatment
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Choanal atresia is a congenital condition that is detected at the time of birth. In this condition, there is a blockage or narrowing of the choanae (passages that connect the back of the nasal cavity to the throat). This blockage can be made of only bone or a mix of bone and membranes.  

“If a newborn baby cannot have a thin tube passed through their nose into the throat, it raises concerns and should be checked by a doctor,” says Dr Vaishali Suryawanshi, a paediatrician in Bengaluru.  

Types of choanal atresia 

 Choanal atresia can occur unilaterally (affecting one side) or bilaterally (affecting both sides).  

Bilateral choanal atresia: In cases of bilateral choanal atresia, where both sides are affected, newborns can experience significant breathing difficulties. Since they are unable to breathe through their nose, they might exhibit cyanosis, which is a bluish discoloration of the skin and mucous membranes due to a lack of oxygen. This happens due to insufficient supply of oxygen into their lungs.   

Unilateral choanal atresia: In this case, the infants might not exhibit cyanosis as they can breathe through one nostril. However, there can still be feeding and breathing difficulties though not as severe as in bilateral cases. 

“If both sides of the nose are blocked, the baby might turn blue because they cannot breathe well. If only one side is blocked, they might not turn blue because at least one nostril is open,” says Dr Suryawanshi. 

Symptoms of choanal atresia  

  • Chest retractions unless the child is crying or breathing through mouth  
  • Difficulty breathing following birth, which may result in cyanosis (bluish discoloration), unless the infant is crying 
  • Feeding difficulties 
  • Audible sounds while breathing 
  • Fluid discharge from the nose 

Treatment for choanal atresia 

According to a research done by Claudio Andaloro, Santa Venera Hospital, Santa Marta and Ignazio La Mantia, University of Catania, Italy, unilateral choanal atresia does not need urgent surgery. It can be deferred until the child is older and the nose resembles that of an adult.  However, it is imperative to watch out for breathing issues.   Using a nasal spray with salt water can help keep the nose clear.  

The research suggests that for infants with severe choanal atresia, urgent care involves putting a tube in their windpipe or using a special nipple to help them breathe through their mouth. Later, the blockage is usually opened with a small procedure. Dr H K Susheen Dutt, senior consultant and ENT specialist, Fortis Hospital, Bengaluru, says that bilateral choanal atresia in a newborn is an emergency. It is best treated by inserting an oral airway (a small tube inserted from the blocked side of the nose at birth) to break the seal formed by the tongue against the palate. This oral airway can be well tolerated for several weeks. 

“Definitive surgery will be necessary for bilateral atresia under general anaesthesia, which can be done endoscopically through the nose without making any external openings or incisions,” he adds. 

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