View source for Choanal atresia

==Background==
[[File:PMC5010437 arh0011601550001.png|thumb|Nasal endoscopic view of posterior choanae, depicting complete atresia bilaterally.]]
*Obliteration or blockage of the posterior nasal aperture
*Incidence is between 1:5000 and 1:8000 live births
*Approximately 60% of cases are unilateral
*More common in girls than in boys

==Clinical Features==

*Clinical presentation will depend on if unilateral or bilateral 
*Unilateral 
**Typically present later in life
**Commonly with purulent nasal discharge and obstruction on the affected side and/or a history of chronic sinusitis
** Rarely will present with respiratory distress

*Bilateral 
**Typically will present in early life with episodes of acute respiratory distress with cyanosis that is relieved with crying and with the return of cyanosis with rest (paradoxical cyanosis)
**May present with feeding difficulty, as they are unable to breathe and feed simultaneously 

*May be an isolated anomaly or associated with a congenital anomaly syndrome (e.g. Treacher-Collins, CHARGE, VACTERL/VATER, Pfeiffer)
*Other congenital anomalies are in present in 50% of individuals with unilateral choanal atresia and 60% of individuals with bilateral choanal atresia

==Differential Diagnosis==

*Deviated or dislocated nasal septum
*[[Nasal septal hematoma]]
*[[Nasal polyp]]
*Chordoma
*Isolated piriform aperture stenosis
*Nasal dermoid
*Nasolacrimal duct cyst
*Turbinate hypertrophy

==Evaluation==
[[File:Membranoese Choanalatresie beidseits NG - CT axial und coronar - 001 -Annotationen.png|thumb|Bilateral choanal atresia on CT scan.]]
*Examiner can attempt to pass a 5 or 6 fr catheter from the nose to the oropharynx, alternatively the examiner can use a qualitative measure of nasal airflow (i.e. the movement of a wisp of cotton under the nostrils, fogging of a mirror)
*Diagnosis is confirmed with CT imaging with intranasal contrast
*Ideally diagnosis of this condition should be done immediately after birth
*A thorough physical exam should also be performed to detect associated anomalies

==Management==
*Unilateral
**Generally does not require emergent surgical repair, but respiratory status should be carefully considered. 
**Nasal saline can be helpful for keeping the nasal route clear
*Bilateral
**If presenting with respiratory distress, individuals require immediate airway management, either with an oral airway or endotracheal intubation <ref> Andaloro, C. and Mantia, I., 2020. Choanal Atresia. [online] Ncbi.nlm.nih.gov. Available at: <https://www.ncbi.nlm.nih.gov/books/NBK507724/> </ref>
**Definitive management is surgical repair

==Disposition==

==See Also==

==External Links==

==References==
<references/>

[[Category:Pediatrics]]
[[Category:ENT]]