In the choanal is a congenital malformation at the transition from the nose to the throat. Rapid therapeutic measures are often important.
What is choanal atresia?
Choanal atresia is a complete closure of the posterior nostril that exists from birth. The rear nostril (consisting of the paired choanals) represents the transition between the nasal and pharynx.
Due to the paired structure of the nasal opening, choanal atresia can be unilateral or bilateral. In the majority of cases, choanal atresia occurs on one side. In most cases of choanal atresia, the occlusion of the nasal opening is bony, while in rarer cases it can also take the form of a membrane.
According to DigoPaul, choanal atresia is a malformation and occurs comparatively rarely.
Since infants up to about 6 weeks old can only breathe in through the mouth to a very limited extent, bilateral choanal atresia often leads to severe shortness of breath, especially while drinking. A possible symptom of unilateral choanal atresia is the leakage of purulent mucus from the affected nostril.
Usually, choanal atresia is due to a disruption during embryonic development. The posterior nasal opening is formed between the 3rd and 7th week of embryo; if this development is disturbed, choanal atresia is a possible consequence. The type of developmental disorder present determines whether the later choanal atresia is of a bony or membranous structure.
Symptoms, ailments & signs
One of the typical signs of choanal atresia is complete closure of the posterior nostril. This results in complaints such as shortness of breath, secretions from the nose and mouth and dominant mouth breathing. Due to insufficient nasal breathing, affected infants suffer from shortness of breath when drinking, which can result in reduced food intake.
Breathing pauses can occur, which is a life-threatening complication, especially in the case of severe choanal atresia. Outward signs of the malformation are the noticeable mouth breathing and the paleness. Often the skin is waxy and the eye sockets are sunken. In unilateral choanal atresia, the turbinates are bluish in color.
The signs of a unilateral disease often only appear after days or weeks. If both sides are affected, the malformation is usually diagnosed immediately after birth. If the disease is not treated promptly, it can lead to acute food intake problems, which can lead to deficiency symptoms and other problems.
In the long term, untreated choanal atresia can cause developmental disorders. The lack of oxygen supply to the brain can cause various complications, which depend on the severity of the disease. To avoid this, treatment must be initiated immediately if a malformation is suspected.
Diagnosis & course
If choanal atresia is suspected in a patient due to the symptoms mentioned, such as shortness of breath or unilateral discharge of mucus from the nose, this can be checked diagnostically in various ways.
First of all, it is possible to insert a soft catheter into the nose to determine whether there is patency from the nose to the throat. The same can also be checked by injecting air with the help of a balloon.
If further examination steps are necessary to check the suspicion of choanal atresia, the attending physician can use a nasal speculum or nasal endoscope, for example; These are medical instruments that can be used to examine various structures inside the nose.
The course of a unilateral choanal atresia usually only brings characteristic symptoms after a few weeks in infants. A bilateral choanal atresia, on the other hand, often manifests itself very early; such as breathing through the mouth, which is rarely seen in infants in general. The prognosis of choanal atresia is usually favorable with appropriate medical treatment.
Choanal atresia can have various complications. These depend primarily on the severity of the symptom and the malformations. In most cases, however, the posterior nostril is completely closed. As a result, the patient increases much less air than a healthy person, which leads to shortness of breath in many of those affected.
In addition to shortness of breath, stressful situations often lead to panic attacks and sweating. In many cases, the undersupply can lead to tiredness and headaches. The patient has to compensate for this shortness of breath while breathing through the mouth in order to get enough oxygen. The quality of life is reduced by the choanal atresia.
If the choanal atresia occurs directly in small children and babies, surgical interventions must be carried out immediately to prevent death. Food cannot be given directly by mouth either and is transported through a tube. As a rule, the operations proceed without further complications and lead to success. The person concerned can then breathe freely again.
If choanal atresia develops again in the course of life, another operation is usually necessary. With early treatment, there is no reduction in life expectancy.
When should you go to the doctor?
If choanal atresia is detected at birth, surgical treatment is usually carried out immediately. In other cases, the nurse or doctor must be informed immediately of the unusual breathing. An intervention is necessary in any case with the congenital malformation and should be carried out immediately. Parents who notice abnormal mouth breathing, shortness of breath and other signs of choanal atresia in their child should speak to their pediatrician quickly.
If the posterior nostril is completely closed – this is noticeable by pronounced shortness of breath – it is no longer possible to wait to see a doctor. Sudden panic attacks and sweats are also clear warning signs that require medical evaluation. If choanal atresia develops again in the course of life, the family doctor must be consulted. In the event of a specific suspicion, the ear, nose and throat doctor or a specialist can be consulted directly for the respective symptom. Emergency medical help is required if you suddenly experience severe shortness of breath with panic attacks.
Treatment & Therapy
In most cases, bilateral choanal atresia in the infant requires immediate emergency medical attention. One of these measures is first of all to keep the newborn’s airways free; this is done, for example, by placing a so-called pharynx tube.
In some cases of bilateral choanal atresia, intubation (artificial ventilation) of the infant may also be necessary. In order not to additionally influence mouth breathing, the food is also often administered via a tube.
Surgeons are usually called in as quickly as possible for further treatment steps; If choanal atresia only has slight, membranous occlusions of the posterior nasal opening, these occlusions can occasionally be broken with the help of a nasal catheter. Bony occlusions in the context of a choanal atresia, on the other hand, are usually removed surgically; In the first few days of an infant’s life, such surgical measures can initially be provisional (preliminary).
A final operation is then carried out a few weeks or months later, depending on the medical assessment (the operation can be carried out from the nose or the throat). After successful surgical treatment of bilateral choanal atresia, for example, splints help keep the airways free.
In the case of a unilateral choanal atresia, a surgical intervention can often be sufficient even in school age, depending on the individual case.
Outlook & forecast
Immediate treatment is necessary for choanal atresia. If this disease is not treated after the birth, the affected person usually dies of the symptoms. If the treatment is delayed, the insufficient supply of oxygen can also damage the internal organs or the brain. In most cases, these can no longer be corrected and are therefore irreversible. The extent of this damage depends heavily on the duration of the undersupply.
After the first procedure, an additional procedure is carried out after a few months, which keeps the airways permanently free. After that, the patient does not suffer from any further complaints or restrictions and there is also no reduced life expectancy.
Life expectancy is only negatively affected if the choanal atresia is not treated in time. If the choanal atresia occurs only on one side, immediate treatment is usually not necessary. Here, a surgical procedure is usually still sufficient even in school age. The procedure completely resolves the symptoms and minimizes the risk of renewed choanal atresia.
Since choanal atresia is already congenital, the malformation can usually not be prevented. A worsening of symptoms and possibly life-threatening shortness of breath in infants can usually be prevented through immediate medical measures. A risk of recurrence of choanal atresia after successful treatment is counteracted by appropriate splints in the operating area.
With choanal atresia, the options for follow-up care are extremely limited in most cases. As a rule, the person concerned is always primarily dependent on medical treatment by a doctor so that there are no further complications or further worsening of the symptoms. The earlier a doctor is contacted for choanal atresia and treatment is initiated, the better the further course of the disease will usually be.
Independent healing is not possible. In most cases, choanal atresia involves an operation that completely relieves the symptoms. There are no particular complications. However, the person affected should rest after the procedure and take care of their body. It is advisable to take care of your nose and protect it particularly well.
To avoid infection or inflammation, the affected person should also take antibiotics after the procedure. It should be noted that these should not be taken together with alcohol. The life expectancy of the person affected is usually not reduced by choanal atresia. Furthermore, no further follow-up measures are necessary.
You can do that yourself
Choanal atresia is a medical emergency. First aiders must call the ambulance service and provide first aid to the person concerned. A light seal can often be pierced by yourself, for example with a nasal catheter or other aids. The patients then require inpatient treatment.
After a procedure, the diet must be changed. Avoid foods that could irritate the respiratory tract. These include spicy, sour, cool, hot, and hard-to-chew foods. Those affected should follow the doctor’s instructions. The doctor will make strict guidelines on how to take the medication. Strict care of the nasal passages is also essential.
This can prevent the rear nostrils from closing again. If athresia recurs, surgery may be necessary. Finding the cause can also be supported by the patient by creating a complaint diary or consistently looking for triggers for the complaints.
If these measures do not have any effect, a visit to a doctor is recommended. Most suppurations or other complaints can be remedied with light medication. Endurance sports, yoga or Pilates are recommended to improve breathing ability.