Choanal Atresia: Types, Symptoms, Causes, and Treatment

Newborns do a lot of impressive things on day onelike existing. But multitasking? Not really. And one of the
big “built-in assumptions” of early life is that babies breathe through their noses most of the time. So when
the back of the nasal airway is blocked at birth, breathing can get complicated fast.

Choanal atresia is a congenital condition where one or both choanae (the openings at the back of the nasal
passages that connect to the throat) are blocked by abnormal tissuebone, soft tissue, or a mix of both. The
good news: it’s treatable. The urgent news: bilateral (both sides) choanal atresia can be a medical emergency in
a newborn and needs rapid evaluation and airway support.

This guide covers the main types, the classic symptoms (including the weirdly specific clue that can show up at
feeding time), why it happens, how it’s diagnosed, and what treatment and recovery typically look likeplus
real-world experiences families often describe after diagnosis and surgery.

What Is Choanal Atresia?

The nose isn’t just for smelling pizza and detecting when someone opened a bag of chips from three rooms away.
It’s also the front door for airflow. The choanae are the “back doors” of the nasal cavitytwo openings that
let air travel from the nose into the nasopharynx (upper throat).

In choanal atresia, one or both of these openings are blocked. The blockage can be:

• Bony (mostly bone)
• Membranous (mostly soft tissue)
• Mixed (a combination of bone and soft tissue, which is common)

Sometimes you’ll also hear choanal stenosis, which means the opening is narrowed rather than completely blocked.
That distinction matters because narrowing may cause milder or later symptoms than full obstruction.

Why Newborns Can Struggle So Much: The “Nose-Breathing Default”

Many newborns are described as “obligate nasal breathers,” meaning they strongly prefer (and are anatomically
set up) to breathe through the nose, especially during feeding. They can breathe through their mouths, but
they don’t always do it efficiently right awaykind of like owning a spare key but not remembering where you
put it.

That’s why bilateral choanal atresia can cause respiratory distress soon after birth: if both back openings are blocked,
airflow through the nose is severely limited.

Types of Choanal Atresia

1) Unilateral vs. Bilateral

• Unilateral choanal atresia: One side is blocked. Symptoms may be mild and sometimes show up later.
• Bilateral choanal atresia: Both sides are blocked. This often causes immediate breathing trouble in newborns and
  usually requires urgent airway management and early surgical planning.

2) Bony, Membranous, or Mixed

Clinicians often describe the blockage by what it’s made of:

• Bony: harder obstruction
• Membranous: softer obstruction
• Mixed: bone + soft tissue (commonly reported)

3) Atresia vs. Stenosis

“Atresia” implies the opening is blocked; “stenosis” implies it’s narrowed. Both can affect breathing, but
stenosis may present with subtler symptomsthink chronic congestion rather than a dramatic newborn emergency.

Symptoms: What Choanal Atresia Looks Like in Real Life

Symptoms in Newborns (especially bilateral cases)

With bilateral blockage, signs can appear right away. Common red flags include:

• Difficulty breathing, especially when calm or feeding
• Noisy breathing or distress
• Cyanosis (bluish color) that may worsen during feeding and improve when crying
  (crying forces mouth breathingyes, even newborns can accidentally “find a workaround”)
• Feeding trouble because babies coordinate breathing and sucking… until breathing becomes the limiting factor

Symptoms in infants/children (often unilateral cases)

Unilateral choanal atresia may be missed at birth and show up as persistent one-sided symptoms, such as:

• Chronic nasal congestion on one side
• Persistent runny nose (often on one side)
• Recurring sinus or upper respiratory infections (sometimes)
• Noisy breathing or snoring in some cases

Symptoms in teens/adults (rare, usually partial/unilateral)

It’s uncommon, but a person can reach later childhood or adulthood before diagnosisusually if the condition
is unilateral or not fully obstructed. Symptoms tend to resemble long-standing one-sided nasal blockage that
never quite responds to standard treatments.

When to treat it like an emergency

If a newborn has breathing difficulty, turns blue, struggles to feed, or shows signs of respiratory distress,
that’s an emergency. In the U.S., call 911 or seek emergency care immediately. Choanal atresia is one possible cause,
but doctors also need to rule out other urgent airway or heart-related problems.

Causes and Risk Factors

What causes choanal atresia?

Choanal atresia happens during fetal development when the back of the nasal passage doesn’t form an open
connection to the throat as it should. The exact reason can be unclear in many cases, and research continues
to explore genetic and environmental contributors.

Associated syndromes and other conditions

Choanal atresia can occur by itself, but it’s also associated with certain syndromes and other congenital
anomalies. One of the most well-known associations is CHARGE syndrome. It may also be seen alongside other craniofacial
differences or developmental conditions, which is why clinicians often perform a broader evaluation after
diagnosis.

Why the “big picture” workup matters

If choanal atresia is part of a broader syndrome, treatment planning may involve more than the nosefeeding
support, hearing evaluation, heart checks, and coordinated care across specialties. That’s not meant to be
scary; it’s meant to be efficient. One diagnosis can be a helpful clue to look carefully for other needs
early, when help makes the biggest difference.

How Doctors Diagnose Choanal Atresia

Bedside exam and early clues

In a newborn with suspected choanal atresia, clinicians may notice trouble passing a small tube (catheter)
through the nostril into the back of the throat. That’s not the final word, but it can be an important early
clue.

Nasal endoscopy

A tiny camera (endoscope) can help visualize the nasal passage and confirm whether the back opening is blocked
or narrowed. Endoscopy also helps doctors assess the anatomy in a way that guides surgical planning.

CT scan

CT imaging is commonly used to confirm the diagnosis and define whether the obstruction is bony, membranous,
or mixed. This detail helps the surgical team decide on the best approach.

Checking for associated issues

Because choanal atresia can occur with other congenital anomalies, clinicians may recommend additional
evaluations based on the baby’s exam and history (for example, looking at heart, hearing, eyes, and other
features when CHARGE or another syndrome is suspected).

Treatment: From Immediate Breathing Support to Surgical Repair

Step 1: Stabilize breathing (especially in bilateral cases)

If both choanae are blocked and a newborn is struggling to breathe, the priority is airway support. This may
include temporary measures like an oral airway or intubation, depending on severity and the clinical setting.

Step 2: Definitive treatment is usually surgery

The main treatment for choanal atresia is surgical repair to create a patent (open) airway. Today, many
centers consider transnasal endoscopic repair a standard approach because it allows precise work through the nostrils
using an endoscope, without needing larger incisions.

The goal is straightforward (even if the execution is very “microsurgery-level”): remove the blockage and
create a stable opening that stays open as the child heals and grows.

Stents: sometimes used, sometimes avoided

After repair, some surgeons place nasal stents to help keep the new opening open during healing. However, stenting is
debated in the medical literature: some evidence suggests similar success rates with and without stents, and
stents can be associated with complications like irritation, infection, or scar tissue. Many teams use stents
selectively rather than automatically.

Timing of surgery: why unilateral cases may be scheduled differently

Bilateral choanal atresia often needs early intervention because breathing issues are immediate. Unilateral
cases, especially when symptoms are manageable, may be repaired later (for example, after infancy) depending
on the child’s health, anatomy, and the care team’s plan.

Post-op care and follow-up

After surgery, follow-up is crucial because the main long-term risk is restenosis (re-narrowing due to scarring). Post-op
care plans vary, but often include:

• Regular ENT follow-ups to check healing and airway patency
• Nasal saline or gentle cleaning guidance (age-appropriate and surgeon-specific)
• Monitoring feeding and growth, especially in infants with complex medical needs
• Watching for signs of infection or increasing obstruction

Recovery and Long-Term Outlook

What recovery usually feels like (for parents and kids)

For families, recovery can be emotionally intenseeven when everything goes “according to plan.” It’s normal
to feel hyper-alert about breathing sounds, feeding, and congestion. Your ENT team will usually give clear
instructions on what’s expected versus what needs a call right away.

Prognosis

Many children do very well after repair, especially when choanal atresia is isolated. Outcomes can be more
complex when the condition is part of a syndrome like CHARGE, mainly because other medical issues may affect
breathing, feeding, and overall development. The key theme is follow-up: the more consistently the airway is
monitored, the faster teams can respond if narrowing returns.

Questions to Ask Your ENT Team

• Is the blockage unilateral or bilateral? Complete atresia or stenosis?
• Is the obstruction bony, membranous, or mixed (and does that change the surgical plan)?
• Will a stent be used? If so, for how longand what care does it require?
• How will we monitor for restenosis, and what symptoms should prompt a call?
• Should we evaluate for associated conditions or a syndrome such as CHARGE?
• What feeding support is recommended right now?

Real-World Experiences: What Families Often Describe (Extra )

Medical explanations are important, but families live the day-to-day version. While every child’s story is
unique, certain experiences come up again and againespecially in the first weeks after diagnosis.

“Something’s wrong… but it’s weirdly inconsistent.”

Parents of babies with bilateral choanal atresia often describe an early pattern that feels confusing at
first: breathing looks worse when the baby is calm or feeding, but improves when the baby cries. That contrast can
feel almost impossiblehow can crying help? Once clinicians explain that crying forces mouth breathing, the
pattern suddenly makes sense. Families sometimes say that learning this detail felt like finding the missing
piece of a puzzle they didn’t know they were holding.

The NICU learning curve is real (and it’s not a test you studied for)

When airway support is needed, parents quickly get introduced to a world of monitors, respiratory terms, and
care routines. Many describe the emotional whiplash: fear during breathing episodes, relief when the airway is
stabilized, then a new kind of stress waiting for surgery. A helpful mindset some parents share is focusing on
“today’s job”: today is about breathing stability; tomorrow is about imaging; the next day is about the
surgical plan. Breaking it into steps can make it feel less overwhelming.

Unilateral cases can be a long mystery

Families of children with unilateral choanal atresia often describe a different journey: months (sometimes
years) of “one nostril always seems plugged,” persistent one-sided drainage, or recurring congestion that
doesn’t fit the usual allergy/cold pattern. It’s not uncommon for parents to feel validated when the diagnosis
is finally madebecause it confirms that the problem wasn’t “overreacting,” it was anatomy.

Post-surgery life: better breathing, plus a lot of follow-up

After repair, many families notice improvements in breathing and feedingsometimes quickly, sometimes
gradually. But recovery isn’t always a straight line. Congestion during healing can sound dramatic, and babies
can still get regular colds like everyone else (because viruses do not respect postoperative calendars). What
families often emphasize is that follow-up visits help keep anxiety in check: having the ENT team confirm the
airway is open can be deeply reassuring.

If CHARGE or another syndrome is involved, care becomes a team sport

Some families describe choanal atresia as the “first big sign” that led to discovering additional needslike
feeding therapy, hearing support, or heart evaluations. While that can feel daunting, many also describe
gratitude for coordinated specialty care. Over time, families often become expert organizers: they keep a
symptom log, bring a question list to appointments, and learn which signs mean “normal healing” versus “call
today.” (Pro tip from seasoned parents: write things down, because sleep deprivation will erase your short-term
memory like it’s a whiteboard.)

Conclusion

Choanal atresia is rare, but it’s well-recognized and treatableespecially when diagnosed early and managed by
an experienced pediatric ENT team. The most important distinction is whether the blockage is unilateral or
bilateral, because bilateral choanal atresia can cause urgent breathing problems in newborns. Diagnosis often
involves endoscopy and CT imaging, and treatment commonly includes transnasal endoscopic surgical repair with
careful follow-up to prevent or catch restenosis.

If you’re a parent navigating this diagnosis, it’s okay to feel overwhelmed. The path forward usually becomes
clearer once the airway is stabilized, the anatomy is defined, and a surgical plan is in place. One step at a
timepreferably with snacks.