Choanal atresia


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


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


  • 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 [1]
    • Definitive management is surgical repair


See Also

External Links


  1. Andaloro, C. and Mantia, I., 2020. Choanal Atresia. [online] Available at: <>