What is a choanal atresia?Due to insufficient nasal breathing affected infants suffer from shortness of breath when drinking, which may result in reduced food intake.
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Choanal atresia is a complete occlusion of the posterior nasal cavity that exists from birth. The posterior nostril (consisting of the paired choanal) represents the transition between nasal and pharyngeal space.
Due to the paired structure of the nasal opening, a choanal atresia can be present both on one side and on both sides. In the majority of cases, choanal atresia occurs unilaterally. In most cases of choanal atresia, the present obstruction of the nasal opening is bony, while in rarer cases it may take the form of a membrane.
The choanal atresia is a medical definition of a malformation and occurs relatively rarely.
Since infants can inhale only to a very limited extent by the mouth up to the 6th week of life, bilateral choanal atresia, especially during drinking, often leads to severe respiratory distress. A possible symptom of unilateral choanal atresia is the leakage of purulent mucus from the affected nostril.
Choanal atresia is usually due to a disorder during embryonic development. The posterior nostril forms on average between the 3rd and 7th embryonic week; If this training is disturbed, Choanal atresia is a possible consequence. The type of developmental disorder determines whether a later choanal atresia is bony or membranous.
Symptoms, complaints & signs
Typical signs of choanal atresia include complete occlusion of the posterior nostril. This causes symptoms such as shortness of breath, secretions from the nose and mouth as well as a dominant mouth breathing. Due to insufficient nasal breathing affected infants suffer from shortness of breath when drinking, which may result in reduced food intake.
There may be respiratory distress, which is a life-threatening complication, especially in severe choanal atresia. External signs of malformation are the conspicuous mouth breathing and the paleness. Often the skin is waxy and the eye sockets are sunken. In a one-sided choanal atresia, the turbinates are bluish discolored.
The signs of a one-sided illness often only appear after days or weeks. If both sides are affected, the malformation is usually detected immediately after birth. Failure to treat the condition promptly can lead to acute feeding problems that can lead to deficiency symptoms and other problems.
In the long term, untreated choanal atresia can cause developmental disorders. Due to the lack of oxygen supply to the brain, various complications may occur, depending on the severity of the disease. To avoid this, treatment must be initiated immediately if a malformation is suspected.
Diagnosis & History
If a patient is suspected to have choanal atresia due to symptoms such as shortness of breath or one-sided discharge of mucous from the nose, this can be diagnosed in various ways.
First, it is possible to insert a soft catheter into the nose to determine if there is patency from the nasal to the pharynx. The same can also be tested by an air injection, which takes place with the help of a balloon.
If further examination steps are necessary in order to check the suspicion of a choanal atresia, the treating physician can, for example, use nasal speculum or nasal endoscope; These are medical instruments that can be used to examine various structures of the inside of the nose.
The course of a one-sided choanal atresia usually causes symptoms in infants only after a few weeks. On the other hand, bilateral choanal atresia often manifests itself very early; for example, by mouth breathing, which is rarely seen in infants in general. The prognosis of a choanal atresia with appropriate medical treatment is usually favorable.
Choanal atresia can lead to different complications. These depend mainly on the expression of the symptom and the malformations. In most cases, however, there is a complete closure of the posterior nostril. As a result, the patient increases much less air than a healthy person, which leads to respiratory distress in many people.
In addition to respiratory distress, it often comes in stressful situations to panic attacks and sweats. The undersupply can lead to fatigue and headaches in many cases. The patient must balance this shortness of breath while breathing through the mouth to get enough oxygen. The quality of life is reduced by the choanal atresia.
If the Choanal atresia occurs directly in infants and babies, immediate surgery must be performed so that it does not die. The food can not be administered directly through the mouth and is transported via a probe. As a rule, the operations proceed without further complications and lead to a success. The affected person can then breathe freely again.
If choanal atresia develops again in the course of life, a second operation is usually necessary. Early treatment does not lead to reduced life expectancy.
When should you go to the doctor?
If a choanal atresia is detected at birth, usually an operative treatment is performed directly. In other cases, the caregiver or doctor must be promptly informed of the unusual breathing. Surgery is necessary for the congenital malformation in any case and should be done immediately. Parents who notice abnormal mouth breathing, shortness of breath, and other signs of choanal atresia with their child are best advised to speak quickly with the pediatrician.
Full closure of the posterior nasal opening - which manifests itself as a pronounced respiratory distress - must not be waited for with the doctor's visit. Sudden panic attacks and sweats are also clear warning signs that require medical clarification. If, during the course of life, a choanal atresia should develop again, the family doctor must be consulted. If there is a specific suspicion, the ear, nose and throat specialist or a specialist for the respective symptom can be consulted directly. Emergency medical help is required if there is a sudden shortage of breath with panic attacks.
Treatment & Therapy
In most cases bilateral choanal atresia in the infant requires immediate emergency medical procedures. These measures include, first of all, keeping the respiratory tract of the newborn free; This happens, for example, by laying a so-called throat tube.
In some cases of bilateral choanal atresia, intubation (ie artificial ventilation) of the infant may be necessary. In addition, to not additionally affect mouth breathing, food is often administered via a probe.
For further treatment steps surgeons are usually consulted as quickly as possible; If there are only slight, membranous occlusions of the posterior nostril in choanal atresia, these occlusions may occasionally be punctured using a nasal catheter. Bony occlusions in the context of choanal atresia, however, are usually repaired surgically; In the first days of life of an infant, such operative measures may initially be provisional.
Depending on the medical assessment, a final operation will then take place a few weeks or months later (surgery can be performed on the nose or throat). After a successful surgical treatment of bilateral choanal atresia, for example, splints help to keep the airways clear.
In a unilateral choanal atresia, surgical intervention may often be sufficient in school age, depending on the individual case.
Outlook & Forecast
Choanal atresia requires immediate treatment. If after treatment no treatment of this disease occurs, then the affected person usually dies of the symptoms. In the case of delayed treatment, oxygen deficiency can also damage the internal organs or the brain. These can not be corrected in most cases and are thus irreversible. The extent of this damage depends heavily on the duration of the shortage.
After the first procedure, an additional procedure takes place after a few months, keeping the respiratory tract permanently free. Thereafter, the patient suffers no further discomfort or restrictions and there is no reduced life expectancy.
Life expectancy is only negatively affected if the choanal atresia is not treated in time. If the choanal atresia is unilateral, immediate treatment is usually unnecessary. Here, a surgical intervention is usually sufficient even at school age. The discomfort is completely resolved by the procedure and the risk of renewed choanal atresia is minimized.
Since a choanal atresia is already innate, the malformation can not be prevented as a rule. Symptom aggravation and possibly life-threatening respiratory distress in infants, however, are usually prevented by immediate medical measures. A risk of recurrence of choanal atresia after successful treatment is counteracted by appropriate splints in the surgical area.
In a choanal atresia, the options for follow-up 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 a further worsening of the symptoms. The earlier a doctor is contacted during Choanal atresia and treatment is initiated, the better the general course of the disease is, as a rule.
An independent healing is not possible. In most cases, choanal atresia involves surgical intervention that completely relieves the symptoms. There are no special complications. However, the affected person should rest after the procedure and protect his body. It is advisable, above all, to protect the nose and to protect it particularly well.
To avoid infection or inflammation, the person should take antibiotics after the procedure. It should be noted that these should not be taken with alcohol. The life expectancy of the affected person is usually not reduced by choanal atresia. Furthermore, no further measures of aftercare are necessary.
You can do that yourself
A choanal atresia represents a medical emergency. The first responders must call the emergency medical service and provide the affected first aid. A slight occlusion can often be self-pierced, such as with the nasal catheter or other aids. Patients then require inpatient treatment.
After an intervention, the diet must be changed. Foods that may irritate the respiratory system should be avoided. These include hot, sour, cool, hot and hard-to-chew food. Those affected should follow the doctor's instructions. The physician will make strict guidelines regarding taking the medication. Strict care of the nasal passages is also essential.
This can prevent the rear nostrils from closing again. Should it come to athresia repeatedly, surgery may be needed. Cause determination can also be supported by the patient by creating a complaint diary or by consistently looking for triggers for the complaints.
If these measures are not effective, a visit to a doctor is recommended. In most cases, suppurations or other complaints can be remedied by using light medications. To improve the ability to breathe, endurance sports, yoga or Pilates are recommended.