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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Neonatology

What is Choanal Atresia? An Introduction for Parents

At a Glance

Choanal atresia is a rare birth defect where a newborn's nasal passage is blocked by bone or tissue. Because infants naturally breathe only through their noses, a blockage in both nostrils is a medical emergency requiring immediate respiratory support and eventual corrective surgery.

Finding out your newborn has a medical condition can be overwhelming and frightening, especially when it involves something as fundamental as breathing. It is important to know that choanal atresia is a physical, structural blockage in the nose—it is not an illness, an infection, or something you did “wrong” during pregnancy [1][2]. With modern medical care, this condition is highly treatable, and your care team is focused on ensuring your baby can breathe safely and comfortably.

Understanding the Blockage

At the very back of the nasal passage, there is an opening called the choana that connects the nose to the throat. In babies with choanal atresia, this opening failed to develop properly during the first few weeks of pregnancy [3][2]. Instead of a clear pathway, the area is blocked by a wall of tissue [4].

There are three main ways this blockage can form:

  • Bony: The blockage is made entirely of solid bone.
  • Membranous: The blockage is a thin, soft “skin-like” membrane [5].
  • Mixed: This is the most common form, where the blockage is made of both bone and membrane [6][7].

Why It Is a Medical Priority

Newborn babies are what doctors call obligate nasal breathers. This means that for the first several weeks of life, their bodies are naturally “wired” to breathe only through their noses, not their mouths [8][9]. Because of this, a blockage in the nose can make it very difficult for a baby to get enough oxygen.

The urgency of treatment depends on whether the blockage is on one side or both:

  • Bilateral (Both Sides): This is a neonatal emergency [8]. Because both nostrils are blocked, the baby may struggle to breathe immediately after birth and may turn blue (cyanosis) while resting or feeding, only pinking up when they cry (because crying forces them to breathe through their mouth) [10][4].
  • Unilateral (One Side): This is often less urgent and may not be discovered until later in life. Symptoms might include a persistent thick discharge or “stuffiness” on only one side of the nose [11][12].

Facts and Figures

Choanal atresia is a rare condition, occurring in approximately 1 out of every 5,000 to 10,000 live births [13]. Research shows that it is more commonly seen in female infants than in males [13].

In about 50% of cases, choanal atresia occurs alongside other developmental challenges, such as CHARGE syndrome (a specific pattern of birth defects) [14]. For this reason, your doctor will likely perform a thorough checkup to ensure your baby’s heart, eyes, and other organs are developing as they should.

Immediate Next Steps

If your baby has a bilateral blockage, the medical team’s first goal is stabilization. Because this is a medical emergency, your baby will likely be admitted to the Neonatal Intensive Care Unit (NICU). Being in the NICU can be intimidating, with many monitors and wires, but it is the safest place for your baby to receive specialized care.

Stabilization involves creating a way for the baby to breathe through their mouth until surgery can be performed. This might include:

  • Using a McGovern nipple (a specialized nipple with a large hole) or an oral airway (a small plastic device) to keep the mouth open for air [15].
  • Confirming the exact nature of the blockage using a CT scan, which helps the surgeons see if the wall is bone or membrane [16].
  • Planning for a transnasal endoscopic repair, a procedure where surgeons use small cameras and tools through the nostrils to open the pathway without making external cuts on the face [7][17].

Common questions in this guide

What exactly is choanal atresia?
Choanal atresia is a physical blockage at the back of a baby's nasal passage. It happens when the opening connecting the nose to the throat fails to develop properly during pregnancy, leaving a wall of bone, membrane, or both.
Why does my baby turn blue when resting but pink when crying?
Newborns naturally breathe only through their noses. If they have bilateral choanal atresia, they cannot get enough oxygen while resting and may turn blue. Crying forces them to breathe through their mouths, temporarily bringing oxygen into their lungs and turning their skin pink again.
Is choanal atresia always a medical emergency?
It depends on the type of blockage. Bilateral choanal atresia, where both sides are blocked, is an immediate medical emergency requiring NICU care. Unilateral blockage affects only one side and is less urgent, sometimes going undiscovered until thick nasal discharge appears later on.
How is choanal atresia treated?
The immediate goal is stabilizing your baby's breathing using devices like a specialized nipple or oral airway. Once stable, surgeons typically perform a transnasal endoscopic repair, using small cameras and tools through the nostrils to remove the blockage without external cuts.
Will my baby need to be tested for other conditions?
Yes. In about half of all cases, choanal atresia occurs alongside other developmental challenges, such as CHARGE syndrome. Your baby's care team will perform a thorough checkup to ensure their heart, eyes, and other organs are developing normally.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Is my baby's choanal atresia unilateral (one side) or bilateral (both sides), and how does that change the timeline for surgery?
  2. 2.What type of blockage does my baby have: bony, membranous, or a mix of both?
  3. 3.Has my baby been screened for other conditions like CHARGE syndrome?
  4. 4.Who will be on my baby’s care team (e.g., ENT surgeons, neonatologists, feeding specialists)?
  5. 5.What are the immediate steps being taken to stabilize my baby’s breathing?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (17)
  1. 1

    Familial congenital choanal atresia with GATA3 associated hypoparathyroidism-deafness-renal dysplasia syndrome unidentified on auditory brainstem response.

    Kita M, Kuwata Y, Usui T

    Auris, nasus, larynx 2019; (46(5)):808-812 doi:10.1016/j.anl.2018.10.005.

    PMID: 30396722
  2. 2

    Choanal Atresia Repair With Stents and Flaps: A Systematic Review Article.

    Alsubaie HM, Almosa WH, Al-Qahtani AS, Margalani O

    Allergy & rhinology (Providence, R.I.) 2021; (12()):21526567211058052 doi:10.1177/21526567211058052.

    PMID: 35173993
  3. 3

    Choanal Atresia in Adult- Endoscopic Surgery and Reconstruction - A Rare Encounter.

    Sharma V, Das D, Kumar SH, et al.

    Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 2025; (77(4)):1880-1883 doi:10.1007/s12070-025-05394-8.

    PMID: 40226254
  4. 4

    Neonatal Choanal Atresia and Stenosis.

    Robin B, Wambach C, Patel K, et al.

    NeoReviews 2025; (26(6)):e380-e390 doi:10.1542/neo.26-6-022.

    PMID: 40449923
  5. 5

    Choanal Atresia and Craniosynostosis: Development and Disease.

    Lesciotto KM, Heuzé Y, Jabs EW, et al.

    Plastic and reconstructive surgery 2018; (141(1)):156-168 doi:10.1097/PRS.0000000000003928.

    PMID: 29280877
  6. 6

    Features and Strategies in the Management of Choanal Atresia: A 6-Year Retrospective Analysis.

    Kalentakis Z, Stamataki S, Chalkiadakis V, Papapetropoulos N

    The Journal of craniofacial surgery 2021; (32(6)):e535-e539 doi:10.1097/SCS.0000000000007490.

    PMID: 33770044
  7. 7

    Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review.

    Bartel R, Levorato M, Adroher M, et al.

    Acta otorrinolaringologica espanola 2021; (72(1)):51-56 doi:10.1016/j.otorri.2020.01.002.

    PMID: 32439138
  8. 8

    Bilateral choanal atresia diagnosed in a 3-month-old female baby: a case report.

    Abraham ZS, Kahinga AA

    Annals of medicine and surgery (2012) 2023; (85(4)):1227-1230 doi:10.1097/MS9.0000000000000484.

    PMID: 37113842
  9. 9

    Late Diagnosis of Bilateral Choanal Atresia: A Case Report of a Nine-Year-Old Girl.

    Foma W, Bissa H, Adam S, et al.

    Cureus 2022; (14(7)):e27203 doi:10.7759/cureus.27203.

    PMID: 36039226
  10. 10

    Bilateral Membranous Choanal Atresia Without Associated Other Congenital Anomalies in a 16-Year-Old Female Patient: Case Report.

    Dires S, Alemayehu F, Birhanu W

    International medical case reports journal 2023; (16()):775-778 doi:10.2147/IMCRJ.S424558.

    PMID: 38020578
  11. 11

    Bilateral congenital choanal atresia in a preterm neonate - a rare neonatal emergency: A case report and review of literature.

    Zaidi A, Dey AC, Sabra O, James J

    Medical journal, Armed Forces India 2024; (80(1)):115-118 doi:10.1016/j.mjafi.2021.09.011.

    PMID: 38261804
  12. 12

    Unilateral Choanal Atresia in a Child With Prolonged Nasal Congestion.

    Ussher L, David C, Hansen R, et al.

    Cureus 2024; (16(4)):e57669 doi:10.7759/cureus.57669.

    PMID: 38707148
  13. 13

    Surgical Management of Choanal Atresia: Two Classic Cases and Review of the Literature.

    Rossi NA, Benavidez M, Pine HS, et al.

    Cureus 2022; (14(4)):e24259 doi:10.7759/cureus.24259.

    PMID: 35607544
  14. 14

    A recurrence analysis in patients with congenital choanal atresia.

    Yılmaz Topçuoğlu MS, Schuler PJ, Westhoff JH, et al.

    Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 2025; (53(9)):1571-1576 doi:10.1016/j.jcms.2025.07.003.

    PMID: 40628561
  15. 15

    Successful Noninvasive Respiratory Management of an Infant with Bilateral Choanal Atresia and a Supernumerary Nostril Located on the Columella by a Mouthpiece: A Case Report.

    Nakamura N, Kakita H, Takagi M, et al.

    The American journal of case reports 2023; (24()):e939642 doi:10.12659/AJCR.939642.

    PMID: 37357428
  16. 16

    Infant Midnasal Stenosis: Reliability of Nasal Metrics.

    Graham ME, Loveridge KM, Pollard SH, et al.

    AJNR. American journal of neuroradiology 2019; (40(3)):562-567 doi:10.3174/ajnr.A5980.

    PMID: 30765383
  17. 17

    [Choanal atresia repair in Germany : Resection of dorsal septal parts and stents in focus].

    Yılmaz Topçuoğlu MS, Hammitsch-Mayer A, Plinkert PK, Baumann I

    HNO 2024; (72(3)):199-203 doi:10.1007/s00106-023-01410-x.

    PMID: 38189815

This page provides educational information about choanal atresia for parents and caregivers. It is not a substitute for professional medical advice, diagnosis, or immediate emergency care from your baby's medical team.

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