Choanal Atresia

Choanal atresia is a narrowing or blockage of the nasal passageway that results in difficulty breathing. The blockage is due to tissue or bone in the nasal airway that was present at birth. Surgery can address the problem and ease uncomfortable symptoms.


Choanal atresia is categorized by tissue that blocks or narrows the nasal airway.
Babies with choanal atresia have excess tissue in the nasal airway.

What is choanal atresia?

Choanal atresia is a condition in which nasal tissue blocks the nasal airway. Choanal atresia can affect one or both sides of your nose, and the blockage may be made completely of bone or a combination of bone and soft tissue.


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Who does choanal atresia affect?

The condition is congenital, meaning it's present at birth. With unilateral choanal atresia (where one side of the nose is blocked), symptoms can go unnoticed and surface later in adulthood. Bilateral choanal atresia (where both sides of your nose are blocked) is often recognized and treated at birth.

How common is choanal atresia?

Choanal atresia is somewhat rare, occurring in about 1 out of every 7,000 live births. The condition is more likely to affect females than males.


Is choanal atresia an emergency?

Yes, in some cases. When a baby is born with bilateral choanal atresia — meaning the condition affects both sides of the nose — then it’s considered a life-threatening emergency. This is because infants breathe almost exclusively through their noses. (Typically, babies only breathe through their mouths if they’re crying.) If your baby’s nasal airway is completely blocked at the time of birth, they won’t be able to breathe at all. In these cases, your healthcare provider can insert a small tube into the windpipe immediately to help your baby breathe. Once your baby is stable, your provider can perform surgery to permanently correct the problem.

Do babies with choanal atresia have other abnormalities?

Approximately one-half of babies with choanal atresia are born with other abnormalities. CHARGE syndrome is the most common anomaly associated with choanal atresia. CHARGE is an acronym that stands for coloboma (a congenital eye condition that can impair vision), heart defects, atresia choanal (another term for choanal atresia), growth retardation, genital abnormalities and ear abnormalities. CHARGE syndrome causes a variety of symptoms, and each individual can be affected differently. Other choanal atresia associate syndromes include Crouzon, Pfeiffer, Antley-Bixler, Marshall-Smith, Schinzel-Giedion and Treacher Collins Syndrome.


Symptoms and Causes

What are the symptoms of choanal atresia?

Generally, infants with choanal atresia have trouble breathing unless they’re crying. Babies with choanal atresia affecting both sides of the nose may have a bluish discoloration (cyanosis) or have breathing failure at birth. In these cases, resuscitation is performed immediately. Babies that only have blockage on one side of the nose (unilateral choanal atresia) may exhibit other symptoms, such as unilateral nasal drainage or obstruction. Often times the symptoms are mild and not recognized until the child is older.

What causes choanal atresia?

The exact cause of choanal atresia is unknown. There’s a piece of tissue that separates the mouth and nose during fetal development in the uterus. Choanal atresia occurs when that piece of tissue stays intact after the baby is born.

Diagnosis and Tests

How is choanal atresia diagnosed?

In most cases, bilateral choanal atresia is diagnosed when newborns are still in the hospital. If your healthcare provider suspects that your baby has choanal atresia, they may perform some tests, including:

  • A CT (computed tomography) scan. More detailed than an X-ray, this imaging test takes thousands of pictures and stitches them together for a comprehensive, 3-D image.
  • Nasal endoscopy. Your healthcare provider will insert a thin tube with a small camera attached into your baby’s nose to get a better look at the nasal structures.

Management and Treatment

How is choanal atresia treated?

Surgery is the only long-term treatment option for babies with choanal atresia. In some cases, infants can learn to breathe through their mouths, delaying the need for immediate surgery. But eventually, choanal atresia repair is recommended to improve health and quality of life. Endoscopic choanal atresia repair is the most common approach.

During choanal atresia repair, your surgeon creates a hole through the bone or tissue that’s blocking your baby’s airway. This can be achieved through the nose (transnasal) or roof of the mouth (transpalatal). In some cases, a stent may be placed inside your baby’s nasal passage to keep the airway open during healing. Stents are surgically removed a few months after placement. Choanal atresia is performed under general anesthesia in an operating room.

Choanal atresia in adults, though extremely rare, is treated the same way — with surgery.

How can I manage my baby’s symptoms?

Oftentimes, parents of babies with unilateral choanal atresia (where only one side of the nose is blocked) decide to wait on surgery until their infant is a little older. This is fine, as long as your baby doesn’t have severe breathing problems or difficulty eating. In the meantime, ask your healthcare provider how to properly manage choanal atresia symptoms. You may need to flush the nasal passages with saline to keep the tissues clean and healthy

If your baby has been diagnosed with bilateral choanal atresia — affecting both sides of the nose — then surgery is recommended as soon as possible. The goal is to open the nasal passages so your baby can breathe easily on their own.


Can I prevent choanal atresia?

No. Choanal atresia is present at birth. Therefore, there’s no way to prevent it.

Outlook / Prognosis

What can I expect if my baby has choanal atresia?

If your baby is born with choanal atresia, your healthcare provider will discuss all treatment options with you in detail. Though choanal atresia is a rare condition, treatment is usually successful with full recovery expected.

Living With

When should I call my healthcare provider?

Anytime you notice changes in the way your baby is breathing or eating, schedule a visit with your healthcare provider. Sometimes, choanal atresia symptoms don’t surface until later — especially in mild unilateral cases.

A note from Cleveland Clinic

Learning that your baby has choanal atresia can be scary — especially if they have breathing difficulties during the birthing process. Fortunately the condition can be treated successfully with surgery. If you suspect that your baby has undiagnosed choanal atresia, call your healthcare provider so they can perform an examination. Proper treatment can help your child breathe easier and improve their overall quality of life.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 09/30/2021.

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