What is choanal atresia?
When the nose is formed in the womb, the inside part of the nose needs to open towards the throat.
In some children, this opening does not happen. It can involve one or both sides of the nose.
A choanal atresia may be the only problem your child has. Sometimes this might be associated with other medical problems (for example CHARGE syndrome). The doctors will check if every other part of your child’s body is formed correctly. Your child may need to have some tests, such as scans.
What symptoms will my child have?
Babies need to breathe through the nose until they are about 6 months old. They struggle to breathe through the mouth, unlike adults.
A child with choanal atresia cannot breathe through one or both nostrils. You might see the following:
- They could turn blue and pink while crying.
- They may have difficulty feeding and take longer to finish their bottle.
- They might have a constantly runny nose.
How do I know if my child has choanal atresia?
The doctor will clean your child’s nose first. Then they will insert a flexible camera inside the nose. This should confirm if there is a choanal atresia on one or both sides. A CT scan of the head helps clarify if there are other problems.
How is choanal atresia treated?
A baby with choanal atresia on both sides will struggle to breathe. The doctor will temporarily secure their airway. This is done by putting a tube inside the windpipe to help them breathe. Your child may be kept on the neonatal intensive care unit. Choanal atresia can be repaired by making an opening at the back of the nasal passage (or choana). This surgery is performed while your child is asleep, under a general anaesthetic. First, a small connection is made between the inside of the nose and the throat using a camera. Then the opening is made bigger.
Your child’s surgeon might place a plastic tube (called a stent) in the nose to keep the new opening open for a few weeks.
Are there alternative treatments?
Surgery is the only way to make a hole at the back of the nose.
Are there any complications to this operation?
All surgery involves some risks. Complications fall into the following groups.
Sore throat
Your child may have a sore throat after the procedure and cry a lot. This is common. Painkillers can be given to help make your child more comfortable.
Nosebleed
It is common to see a bit of blood in the snot after the procedure. This should settle down on its own.
Unsuccessful surgery
There is a very small risk that the opening is not wide enough. Your child may need another operation. This is uncommon.
There is a small chance that your child may need to remain intubated for a short period of time after the surgery. This is very rare. This means they will be kept asleep with a tube to help them breathe until the swelling settles down.
General anaesthetic
The operation takes place under a general anaesthetic. This is very safe in children. Your child’s pre-assessment team will inform you about the risks of a general anaesthetic. For more information, click here.
What happens after my child’s operation?
After the operation, your child will go back to the ward or neonatal intensive care unit (NICU).
The new opening at the back of the nose needs to heal. There is a risk that it might close again during this time. If this happens, your child may need another surgery to keep the inside open. Your child’s surgeon will discuss this with you.
If your child has a nasal stent (a small tube that keeps the opening from closing), it will need regular cleaning to stop it from getting blocked. The airway nurse or ENT nurse will teach you how to do this.
The surgeon will review your child after the surgery to check the opening has healed properly.
Can my child eat?
Your child can usually be fed later the same day, when they are fully awake. They may be fed via a feeding tube passed from the mouth into the stomach.
How long will my child be in hospital?
Your doctor will tell you how long your child will be in hospital, as this will depend on your child’s condition.
Disclaimer: This publication is designed for the information of patients. Whilst every effort has been made to ensure accuracy, the information contained may not be comprehensive and patients should not act upon it without seeking professional advice.