Choanal Atresia: An Evidence-Based Guide for Patients

Choanal atresia is a congenital blockage at the back of the nose that can affect one or both nasal passages. It may cause noisy breathing, feeding difficulty, or persistent nasal blockage, and diagnosis and treatment are usually guided by ear, nose, and throat specialists.

Overview: what choanal atresia means

Choanal atresia is a birth condition in which the back of the nasal passage is narrowed or blocked by bone, soft tissue, or a combination of both. This blockage affects airflow between the nose and the throat. It can happen on one side of the nose, called unilateral choanal atresia, or on both sides, called bilateral choanal atresia.

The condition matters because newborns usually breathe mainly through the nose, especially during feeding and sleep. When both sides are blocked, breathing can become difficult soon after birth. When only one side is affected, symptoms may be milder and diagnosis may be delayed until infancy or childhood.

Choanal atresia is not caused by anything a parent did during pregnancy in most cases. It develops before birth as the nasal passages and surrounding structures form. Some children have choanal atresia by itself, while others have it as part of a broader syndrome or with other congenital differences.

How choanal atresia can affect breathing and feeding

The effects of choanal atresia depend largely on whether one or both nasal passages are blocked. A baby with bilateral blockage may struggle to move enough air through the nose, which can lead to noisy breathing, bluish color around the lips, or worsening distress during feeding. Breathing may improve when the baby cries because the mouth opens and allows air in.

In unilateral choanal atresia, symptoms are often less dramatic. A child may have chronic stuffiness on one side, persistent nasal discharge, noisy breathing, or difficulty feeding comfortably. Because these symptoms can resemble more common issues such as mucus congestion or recurrent infections, the condition may not be recognized immediately.

Feeding can be especially challenging in infants because they coordinate sucking, swallowing, and breathing at the same time. If the nose is blocked, the baby may need to pause frequently, tire easily, or show signs of distress. Early recognition can help prevent dehydration, poor feeding, and unnecessary delays in treatment.

Symptoms and signs to watch for

Symptoms vary with age and the degree of blockage. In newborns, the most important concern is trouble breathing through the nose. In older infants and children, symptoms may be more subtle but still persistent.

• Noisy breathing or snorting sounds
• Difficulty feeding, choking, or frequent pauses during feeds
• Breathing distress that improves with crying
• Persistent blockage on one side of the nose
• Chronic runny nose, often from one nostril
• Mouth breathing, especially during sleep
• Poor weight gain if feeding is significantly affected

These signs do not always mean choanal atresia, but they do suggest that a structural nasal problem should be considered. Other conditions can also cause nasal obstruction in babies and children, including swelling, infection, enlarged adenoids, or a deviated septum. A proper examination is important to tell these apart.

If a baby seems to have repeated episodes of breathing difficulty, color change, or feeding problems, caregivers should seek prompt medical assessment. Bilateral choanal atresia is often recognized very early because symptoms are more noticeable and can require urgent support.

Causes, associated conditions, and risk factors

Choanal atresia develops during fetal growth when the normal opening between the back of the nose and the throat does not form completely. The exact reason is not always known. In many children, there is no clearly identifiable cause, and the condition appears sporadically.

Some cases occur together with other congenital conditions or syndromes. One of the better-known associations is CHARGE syndrome, which can involve the eyes, heart, nasal passages, growth, genital development, and ears. Because choanal atresia may be part of a wider pattern of differences, doctors often look carefully for related findings once the diagnosis is made.

Doctors may also consider other structural or airway issues that can coexist with nasal blockage, especially in babies with breathing or feeding concerns. Depending on the child’s symptoms, the evaluation may overlap with assessment for adenoid enlargement or other ENT conditions. Families sometimes worry about whether this condition could have been prevented, but in most cases there is no specific action that could have avoided it.

How doctors diagnose choanal atresia

Diagnosis begins with a careful history and physical examination. In a newborn with breathing distress, clinicians may suspect choanal atresia if a small tube cannot be passed easily through the nose into the throat. This simple finding can suggest a blockage, but more detailed testing is usually needed to confirm the anatomy.

An ear, nose, and throat specialist often examines the nasal passages using a small flexible scope, a test called nasal endoscopy. This allows direct visualization of the obstruction and helps identify whether the blockage appears complete or partial. Imaging, especially a CT scan of the nose and sinuses, is commonly used to show the exact structure of the blockage and help plan treatment.

Because some children have associated congenital differences, additional tests may be recommended based on the individual situation. These can include hearing tests, heart evaluation, or genetic assessment if a syndrome is suspected. If there are broader nasal or sinus concerns, the workup may also connect with evaluation of sinus conditions to clarify symptoms and rule out other causes of obstruction.

Treatment options and what recovery involves

Treatment depends on whether the blockage affects one side or both, how severe the symptoms are, and the child’s age and overall health. Bilateral choanal atresia in a newborn is often treated urgently because both nasal passages are blocked. Initial care may focus on helping the baby breathe and feed safely until a definitive procedure can be performed.

The main long-term treatment is surgery to create or widen the opening at the back of the nose. This is typically done by an ENT surgeon, often using endoscopic techniques through the nostrils without external incisions. In selected cases, a child may need temporary support such as suctioning, airway positioning, or alternative feeding strategies before surgery. When surgery is needed, it may be part of a broader plan that can include ENT surgery and close postoperative follow-up.

After the procedure, the care team monitors healing and watches for re-narrowing, which can happen in some children. Follow-up visits may include repeat endoscopic checks and guidance on nasal care. If there are ongoing airway concerns, clinicians may also evaluate related issues such as pediatric surgical care or supportive management for feeding and breathing.

Recovery varies from child to child, but many do well once airflow improves. Parents are usually advised on saline care, gentle cleaning, and how to watch for signs of recurrent blockage. Good follow-up is an important part of treatment because the goal is not only to open the passage, but also to maintain comfortable breathing and feeding as the child grows.

Prevention, home care, and living with the condition

Because choanal atresia is congenital, there is no proven way to prevent it in most cases. What families can do is focus on early recognition, regular follow-up, and good day-to-day care after diagnosis or treatment. Prompt assessment of feeding issues, persistent nasal blockage, or noisy breathing can help prevent complications.

At home, supportive care may include using saline drops if recommended, keeping follow-up appointments, and learning how to feed the baby in a calm and upright position when appropriate. Parents should avoid using over-the-counter remedies or nasal products in infants unless a doctor advises them. If a child has had surgery, the care team may give specific instructions about cleaning, activity, and signs of healing problems.

Children with unilateral choanal atresia or successfully treated bilateral disease often go on to breathe and feed much more comfortably. Some may still need monitoring for growth, sleep quality, ear problems, or recurrent nasal symptoms. Near the end of the care journey, some families also seek multidisciplinary evaluation, and Acibadem International’s specialists in JCI-accredited hospitals diagnose and treat choanal atresia for international patients when coordinated ENT care is needed.

When to seek medical care

Medical care should be sought urgently for any newborn with difficulty breathing, bluish skin or lips, repeated choking during feeds, or pauses in breathing. These symptoms are not specific to choanal atresia, but they require immediate evaluation because newborn airway problems can become serious quickly.

Non-urgent specialist review is appropriate for infants or children with persistent one-sided nasal blockage, chronic discharge from one nostril, mouth breathing, or long-standing noisy breathing. Even when symptoms seem mild, a structural cause may be present and deserves proper assessment.

Parents should also contact a doctor after treatment if symptoms return, feeding becomes difficult again, or there are concerns about infection, worsening congestion, or poor weight gain. A clinician can decide whether the child needs examination, repeat imaging, or referral to an ENT specialist with experience in congenital nasal conditions.

Frequently asked questions

Is choanal atresia present at birth?

Yes. Choanal atresia is a congenital condition, which means it is present at birth. It develops before birth when the back of the nasal passage does not open normally.

What is the difference between unilateral and bilateral choanal atresia?

Unilateral choanal atresia affects one side of the nose, while bilateral choanal atresia affects both sides. Bilateral cases usually cause more obvious breathing problems in newborns and may need urgent treatment.

Can choanal atresia be mistaken for a stuffy nose?

Yes, especially when only one side is blocked. Mild or one-sided symptoms can resemble congestion, mucus buildup, or recurrent nasal infections, which is why persistent symptoms should be assessed by a doctor.

How is choanal atresia confirmed?

Doctors usually confirm the diagnosis with an examination by an ENT specialist, nasal endoscopy, and imaging such as a CT scan. These tests help show the location and type of blockage and guide treatment planning.

Does every child with choanal atresia need surgery?

Not every child needs the same treatment, but surgery is the main definitive treatment for significant blockage. The timing depends on symptoms, whether one or both sides are involved, and the child’s overall condition.

Can choanal atresia come back after treatment?

In some children, the opening can narrow again during healing. That is why follow-up visits are important after treatment, so the care team can monitor breathing, feeding, and nasal healing.

References

• American Academy of Otolaryngology–Head and Neck Surgery
• American Academy of Pediatrics
• National Institute on Deafness and Other Communication Disorders
• MedlinePlus
• Orphanet

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.