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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Pediatrics · Choanal Atresia

Anatomy, Diagnosis, and Associated Syndromes

At a Glance

Unilateral choanal atresia is a physical blockage in one side of a child's nasal passage. Diagnosis requires a high-resolution CT scan after careful nasal suctioning. While often an isolated issue, doctors will routinely screen for associated conditions like CHARGE syndrome.

Choanal atresia occurs when the back of the nasal passage—the choana—fails to open properly during fetal development [1]. This creates a physical wall, known as an atretic plate, that prevents air from traveling from the nose into the throat [1].

Doctors classify this blockage based on what it is made of:

  • Mixed (Bony-Membranous): The most common type, occurring in 56% to 74% of cases. It consists of both hard bone and soft, membrane-like tissue [2][3].
  • Purely Bony: This type is made entirely of bone and accounts for roughly 26% to 30% of cases [3][4].
  • Purely Membranous: The rarest form, consisting only of soft tissue, found in about 10% to 20% of children [3][5].

Understanding the thickness and type of the blockage helps your surgical team plan the most effective way to open the passage [6][7].

Why Suctioning Matters for Diagnosis

The “gold standard” for diagnosing this condition is a high-resolution CT scan [8][9]. Parents are frequently anxious about radiation exposure from CT scans in children; however, modern hospitals use specific “pediatric protocols” to minimize radiation doses during these scans.

A critical step must happen before your child enters the scanner: nasal suctioning.

Because the nasal passage is blocked, thick mucus and secretions naturally pool in the nose. If this mucus isn’t thoroughly suctioned out—and if decongestant drops aren’t used to shrink the nasal lining—the “puddle” of fluid can look exactly like a solid wall on the scan [10][11]. This can lead to a “false positive” or make a thin blockage look much thicker and more complex than it actually is.

Looking at the “Big Picture”

When a child is diagnosed with choanal atresia, doctors often look for other developmental clues. Approximately 30% to 50% of children with this condition have other associated anomalies [12]. The most common association is CHARGE syndrome, a genetic condition often linked to a mutation in the CHD7 gene [12][1].

CHARGE is an acronym that stands for:

  • Coloboma: A gap or “keyhole” in the structure of the eye.
  • Heart defects: Such as holes in the heart or valve issues.
  • Atresia choanae: The blockage of the nasal passages.
  • Restriction of growth and development: Delays in physical growth or learning milestones.
  • Genital abnormalities.
  • Ear anomalies: Including hearing loss or unusually shaped ears [13][14].

Standard Screening: A Proactive Approach

It is important to remember that unilateral (one-sided) atresia is much more likely to be “isolated,” meaning it occurred on its own without any other health problems [1][15]. However, because the stakes are high for a child’s development, it is standard medical practice to perform a proactive “screening” once choanal atresia is found [16][12].

These tests are usually non-invasive and include:

  1. Ophthalmology Exam: A specialist looks at the eyes for colobomas.
  2. Echocardiogram: An ultrasound of the heart to check its structure and function.
  3. Audiometry: A detailed hearing test.
  4. Genetic Consultation: To discuss whether testing for the CHD7 gene is appropriate for your child [12][15][16].

Framing these as routine safety checks helps ensure your child receives comprehensive care from the start [12].

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Common questions in this guide

What causes the blockage in choanal atresia?
Choanal atresia occurs when the back of the nasal passage fails to open properly during fetal development. This creates a wall, called an atretic plate, which can be made of bone, soft tissue, or a mixture of both.
How is unilateral choanal atresia diagnosed?
Doctors diagnose this condition using a high-resolution CT scan. Before the scan, it is critical to use nasal suctioning and decongestant drops. This removes pooled mucus that could otherwise look like a solid wall on the scan, ensuring an accurate diagnosis.
Are there other health conditions associated with choanal atresia?
While unilateral cases are often isolated, about 30% to 50% of children with choanal atresia have other developmental anomalies. The most common is CHARGE syndrome, a genetic condition that can affect the eyes, heart, ears, and physical growth.
What routine screening tests will my child need after diagnosis?
As a proactive safety measure, your child will likely need a few standard, non-invasive tests. These typically include an eye exam, an echocardiogram to check their heart, a detailed hearing test, and a consultation with a geneticist.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What specific anatomical type was found on my child's scan—bony, membranous, or mixed?
  2. 2.Was my child's nose thoroughly suctioned before the CT scan to ensure the images are accurate?
  3. 3.Given that this is a unilateral case, what is the statistical likelihood that this is an isolated finding?
  4. 4.Which specific screening tests—like an echocardiogram or eye exam—should we schedule next?
  5. 5.Are there any physical features you've noticed that might suggest we should consult with a geneticist?

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 (16)
  1. 1

    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
  2. 2

    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
  3. 3

    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
  4. 4

    Surgical Management of Choanal Atresia With Intranasal Hegar's Dilator and Transnasal Endoscopic Excision: A 20-year Retrospective Comparative Study.

    Alshareef MA, Assalem AS, Alzubaidi F, et al.

    Cureus 2020; (12(5)):e8060 doi:10.7759/cureus.8060.

    PMID: 32537278
  5. 5

    A national study of choanal atresia in tertiary care centers in Canada - part I: clinical presentation.

    Paradis J, Dzioba A, El-Hakim H, et al.

    Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 2021; (50(1)):45 doi:10.1186/s40463-021-00517-x.

    PMID: 34253250
  6. 6

    [Endoscopic reconstruction of the posterior nares for the treatment of 46 children with congenital posterior atresia].

    Xie LS, Huang ZH, Li Q, Jiang YZ

    Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery 2019; (33(8)):742-745 doi:10.13201/j.issn.1001-1781.2019.08.014.

    PMID: 31446730
  7. 7

    Choanal atresia surgery: outcomes in 42 patients over 20 years and a review of the literature.

    Attya H, Callaby M, Thevasagayam R

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2021; (278(7)):2347-2356 doi:10.1007/s00405-020-06506-6.

    PMID: 33386964
  8. 8

    False Computed Tomography Findings in Bilateral Choanal Atresia.

    Elsheikh E, El-Anwar MW

    International archives of otorhinolaryngology 2016; (20(2)):163-5 doi:10.1055/s-0035-1570314.

    PMID: 27096022
  9. 9

    Nasal Cavity CT Imaging Contribution to the Diagnosis and Treatment of Choanal Atresia.

    Šebová I, Vyrvová I, Barkociová J

    Medicina (Kaunas, Lithuania) 2021; (57(2)) doi:10.3390/medicina57020093.

    PMID: 33494264
  10. 10

    Clinical and imaging evaluation of Congenital Midnasal Stenosis.

    Levi L, Kornreich L, Hilly O, et al.

    International journal of pediatric otorhinolaryngology 2020; (132()):109918 doi:10.1016/j.ijporl.2020.109918.

    PMID: 32035350
  11. 11

    Midnasal stenosis in adults with normative values.

    Ozturan O, Senturk E, Dogan R, et al.

    The Journal of laryngology and otology 2022; (136(7)):639-644 doi:10.1017/S0022215121004606.

    PMID: 34991747
  12. 12

    [CHARGE syndrome in children with congenital choanal atresia].

    Kotova EN, Bogomilsky MR

    Vestnik otorinolaringologii 2022; (87(3)):7-12 doi:10.17116/otorino2022870317.

    PMID: 35818939
  13. 13

    A Rare Case of Vascular Ring and Coarctation of the Aorta in Association with CHARGE Syndrome.

    Wagner JB, Knowlton JQ, Pastuszko P, Shah SS

    Texas Heart Institute journal 2017; (44(2)):138-140 doi:10.14503/THIJ-16-5819.

    PMID: 28461801
  14. 14

    Prevalence of Semicircular Canal Hypoplasia in Patients With CHARGE Syndrome: 3C Syndrome.

    Wineland A, Menezes MD, Shimony JS, et al.

    JAMA otolaryngology-- head & neck surgery 2017; (143(2)):168-177 doi:10.1001/jamaoto.2016.3175.

    PMID: 27832265
  15. 15

    Diagnostics and therapy of bilateral choanal atresia in association with CHARGE syndrome.

    Koppen T, Bartmann D, Jakob M, et al.

    Journal of neonatal-perinatal medicine 2021; (14(1)):67-74 doi:10.3233/NPM-200450.

    PMID: 32741782
  16. 16

    International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Diagnosis, pre-operative, operative and post-operative pediatric choanal atresia care.

    Moreddu E, Rizzi M, Adil E, et al.

    International journal of pediatric otorhinolaryngology 2019; (123()):151-155 doi:10.1016/j.ijporl.2019.05.010.

    PMID: 31103745

This page provides educational information about choanal atresia diagnosis and associated syndromes. It does not replace professional medical advice, and you should always consult your child's pediatric ENT or pediatrician for diagnostic testing and care.

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