Dorothy FarrarChoanalatresie
Choanal atresia is a malformation at the transition from the nasal cavity to the pharynx. It is congenital and usually requires rapid therapy, which must be started in the first few days of a newborn’s life.
What is choanal atresia?
Choanal atresia (atresia choanae) is a complete closure of the rear opening of the nose. This malformation between the transition between the nose and throat is present from birth. Choanal atresia can occur unilaterally or bilaterally due to the paired structure of the nostrils. Most cases are unilateral choanal atresia, in which the closure of the nostril is bony and rarely takes the form of a membrane.
Choanal atresia is generally rare. As a malformation, this is observed in only one in 5,000 to 10,000 births, with unilateral choanal atresia occurring about five times more frequently than bilateral choanal atresia. Especially in infants up to 6 weeks of age, bilateral choanal atresia can lead to severe shortness of breath when drinking because they can only breathe in through the mouth to a limited extent. With unilateral choanal atresia, leakage of purulent mucus from the corresponding nostril is a possible symptom.
A membranous closure is present in about ten percent of all those affected, and in 90 percent of those affected the closure is bony. The so-called choanae form the transition between the nose and throat as a pair of rear nostrils. The term “atresia” refers to the lack of opening of these choanae. If there is an incomplete closure, this is referred to as a so-called choanal stenosis.
causes
Choanal atresia is attributed to a disorder during embryonic development. In the 3rd to 7th embryonic week, the rear nasal opening (choanae) usually forms. The “membrana oronasalis”, a so-called epithelial duplication, tears between the roof of the oral cavity and the olfactory pit.However, if a disruption occurs during embryonic development, this membrane tears either incompletely or not at all, resulting in an incomplete ( stenosis ) or complete closure (atresia). If there is scattered bone formation from the middle germ layer, a bony closure is formed.
The possible consequence of a disruption in this formation is choanal atresia. Depending on the type of developmental disorder, it can be determined whether the choanal atresia has a membranous or bony structure.
When to the doctor?
An expectant mother should always consult a doctor as soon as she has the feeling that something might be wrong with her unborn child. A diffuse bodily sensation is enough to express the concerns and worries. In addition, it is advisable to attend all recommended check-ups during pregnancy. Here there is already the possibility that anomalies will be detected.
The disorder develops between the 3rd and 7th week of pregnancy. If the pregnant woman has a bad feeling during this time, it is advisable to point this out to the doctor. Shame and restraint are not recommended, even if it is not possible to describe the perception in detail.
As soon as a malformation of the newborn becomes visible during birth, a doctor must be called. In the case of inpatient births, this is done by the nursing staff. The same usually happens with a home birth, which is accompanied by a midwife. If the birth takes place without medical care, an ambulance must be called immediately as soon as the first signs of an irregularity appear.
A doctor must be consulted as soon as possible if the newborn develops breathing problems . Breathing pauses or labored breathing are alarming and need to be investigated. Mouth breathing is considered uncommon in infants. Therefore, a medical professional should be consulted as soon as this is preferred by the newborn.
symptoms and course
Typical symptoms of choanal atresia:
One of the typical symptoms of choanal atresia is the complete closure of the posterior nostril. Shortness of breath, dominant mouth breathing and purulent nasal mucus can also occur. Especially in the case of unilateral choanal atresia, the turbinates of the nose are livid in colour.
Particularly in infants, unilateral choanal atresia only shows the typical symptoms after a few weeks of life. However, the symptoms can be detected very early in bilateral choanal atresia, which can be recognized by mouth breathing, which is rather rare in infants.
In addition, due to the lack of breathing through the nose, infants suffer from shortness of breath when drinking, which leads to reduced food intake. Choanal atresia can be life-threatening for newborns because it can also cause breathing pauses. With appropriate medical treatment, the prognosis for choanal atresia is good.
Diagnose
If the symptoms described suggest the presence of choanal atresia, various diagnostic methods can be used. A diagnosis can be made with a soft catheter inserted into the nose. The patency from the nose to the pharynx is checked.
This check can also be carried out by so-called air injection using a balloon. If further examinations are necessary for the diagnosis, a nasal speculum or a nasal endoscope can also be used to examine the structures inside the nose.
complications
In the worst case, choanal atresia can be fatal. For this reason, the treatment of this malformation is carried out immediately after birth. The patient suffers from severe breathing difficulties. There may be interruptions in breathing or shortness of breath. A lack of oxygen can damage various organs.
However, the further complications depend heavily on how long the undersupply has lasted. Choanal atresia is a very dangerous condition for newborns and infants. If this condition is not treated, the child will die.
In most cases, the treatment is successful and proceeds without complications. Depending on the severity of the choanal atresia, this can be carried out with the help of medication or by surgery. The child can breathe normally again after the treatment and there are no further complaints. The further development of the child is not restricted or impaired with early and successful treatment.
treatment and therapy
In the case of infants in particular, immediate emergency medical measures are required if bilateral choanal atresia is present. It is important that the newborn’s airways are kept free with a so-called pharyngeal tube. Depending on the severity, artificial respiration (intubation) may also be necessary. Because mouth breathing occurs in the presence of choanal atresia, feeding is usually administered through a tube.If there are only slight membranous blockages in choanal atresia, these can usually be perforated with a catheter. However, if it is a question of bony closures, surgical therapy is carried out here, which is carried out temporarily, especially in the first days of an infant’s life.
Only after a few weeks or months does a final operation take place, during which splints are also used to keep the airways clear. If there is only unilateral choanal atresia, depending on the doctor’s assessment, an intervention at school age is sufficient. The operation can be done either through the nose or from the throat.
prevention
Choanal atresia cannot be prevented because it is a congenital malformation. Prevention is only possible in order not to worsen the symptoms. Using splints to keep the airway open can reduce the risk of recurrence.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.