Choanal atresia: Symptoms, causes, diagnosis, treatment and prevention

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Choanal Atresia
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Choanal Atresia

• 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.

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Causes of Choanal Atresia

• 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.

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Causes of Choanal Atresia
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• 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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Symptoms

• 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)

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Diagnosis of Choanal Atresia

• 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

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Treatments

• 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 

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Treatments
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• 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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Prevention of Choanal Atresia

• 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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