Is your baby having trouble breathing? Does his nose feel stuffy? Let's learn about Choanal Atresia

Have you ever noticed a slight difference in the way your newborn baby breathes while you're looking at him? Maybe he breathes well when he's crying, but when he's sleeping and calm, does he seem to have a little trouble breathing through his nose? Or does he stop breastfeeding because he keeps opening his mouth to breathe? It's normal for a mother or father to feel a little scared when they see things like this. Today we're going to talk about a congenital condition that can cause similar symptoms, but is not very well known. That's `Choanal Atresia`.

Simply put, what is Choanal Atresia?

Choanal Atresia (pronounced: ko-a-nal atre-sia) is a condition in which a baby is born with a blockage in the back of their nose, where it connects to their throat (called the choana), by a piece of membrane or bone. Think of the nose as two chambers, with two doors at the back of each chamber blocked. This blockage can be caused by bone, or by a combination of bone and soft tissue.

This condition can affect just one of the baby's nostrils (`Unilateral`) or both nostrils (`Bilateral`). How serious it is and how quickly treatment is needed depends on whether the blockage is on one side or both sides, and how far it is.

What are the two main types of Choanal Atresia?

Let's clearly understand the two main types of this. It will be easier for you if you look at it in a table.

Choanal atresia occurs in about 1 in 7,000 births. Of these, more than 60% are unilateral. It is also twice as common in girls than boys.

What are the symptoms of this condition?

Symptoms vary depending on the two types we discussed earlier.

If both sides of the nose are blocked (Bilateral Choanal Atresia)

Doctors can see these symptoms as soon as the baby is born.

• Severe difficulty breathing: The baby struggles to breathe when he is not crying.
• Blue skin and lips (`Cyanosis`): The baby's skin, lips, and fingernails start to turn blue because the body is not getting enough oxygen.
• Breathing only when crying: Since the baby opens his mouth only when he cries, he breathes only at that time, and the blueness of the skin decreases and becomes pink. When the crying stops, it becomes difficult to breathe again and he turns blue.

If only one side of the nose is blocked (Unilateral Choanal Atresia)

Because these symptoms are not so obvious, you may not notice them until after you bring your baby home. You may not even notice them until years later.

• Restlessness while breastfeeding: The baby needs to breathe through his nose when he is breastfeeding. Since one side is blocked, it is difficult to breathe and the baby stops breastfeeding and opens his mouth. This can make the baby very restless and unable to suck properly.
• Continuous runny nose on one side: If your baby's nose continues to runny on only one side for no apparent reason, without a cold, that is the main and most common symptom of this condition.
• Chest sinking in when crying: When the baby is not crying, the chest may appear to sink in as he struggles to breathe.
• Chronic sinusitis: If you are a little older, you may have frequent sinus infections due to mucus buildup on one side of your nose.

Why is this happening? What is the reason?

The exact cause of this condition is not yet known. However, doctors believe that during the early stages of development of the baby in the womb, there is a membrane that separates the nose and mouth. Normally, this membrane dissolves on its own as the baby grows. However, in some babies, this membrane remains and remains, which is known as `Choanal Atresia`.

Other related conditions

About half of babies with Choanal Atresia have other genetic diseases or birth complications. Although it is not known exactly why, this condition often occurs together with other syndromes.

Among them, the following are the most important:

• CHARGE syndrome: About 60% of babies with bilateral nasal obstruction have CHARGE syndrome.
• `Treacher Collins syndrome`
• `Crouzon syndrome`
• `Pfeiffer syndrome`

Choanal Atresia can be seen with other genetic conditions like this. Therefore, the doctor will check for this as well.

What complications can occur if left untreated?

Especially when there is a blockage on one side, not knowing about it can delay treatment. This can have long-term effects.

• Frequent ear infections: Since there is a connection between the nose and the ear, when one side of the nose is constantly blocked and filled with mucus, it can affect the ear and cause frequent ear infections.
• Hearing loss: Long-term ear infections can damage the ear and, over time, cause hearing loss.
• Aspiration: There is a risk of aspirating milk or food, especially due to difficulty breathing while breastfeeding.

Because of these risks, the doctor will recommend treatment at the most appropriate time.

How to recognize this condition?

A baby with a blocked nose on both sides is usually diagnosed at birth in the hospital. However, when there is a blockage on one side, tests are needed to diagnose it.

1. Breath test: The doctor will hold a small piece of glass near the baby's nostril and check to see if steam is coming out of it. If steam is not coming out of one side, it may indicate a blockage on that side.

2. CT scan: This is the definitive test. It's like taking a 3D picture of the inside of your nose. It can clearly show where the blockage is, whether it's bone or tissue, and how thick it is.

3. Nasal endoscopy: This method uses a tube with a very fine camera inserted into the nose and allows the doctor to view the inside of the nose directly on a screen.

The medical team ensures that the baby is breathing properly during these tests, so there is no risk to the baby.

How is it treated?

The only permanent treatment for Choanal Atresia is surgery.

• If both sides of the nose are blocked: The baby will need surgery as soon as possible.
• If one side of the nose is blocked: Unless the baby is having severe breathing or eating problems, the doctor may decide to postpone the surgery until the baby is a little older.

Surgery

Surgery involves removing the blocked bone or membrane and re-aligning the airway so that breathing can continue. This can be done through the nose (transnasal) or through the palate (transpalatal).

In some cases, a small tube (a `stent`) is placed through the newly created passage after surgery to keep it from closing again. This tube is removed again after a few months through a minor operation. This operation is performed under full anesthesia, so the baby does not feel any pain.

Management at home

If your baby has a unilateral obstruction and the doctor decides to postpone surgery, he or she will give you instructions on how to manage symptoms at home. For example, you may be told to use saline drops to keep the nose clear.

Questions to ask your doctor

When you find out that your baby has this condition, it's normal to have a lot of questions in your mind. Don't be afraid to ask your doctor these questions.

• "Doctor, is my baby's nose blocked on one side or both sides?"
• "Is this condition related to another disease like `CHARGE syndrome`?"
• "When will the baby have to have surgery?"
• "What kind of surgery does the doctor recommend?"
• "How do we know for sure that the surgery was successful?"

Finding out that your baby has Choanal Atresia, especially if they have difficulty breathing at birth, can be very frightening for parents. But remember, this condition can be successfully treated with surgery. After surgery, most babies make a full recovery and breathe without any difficulty throughout their lives. Therefore, if you have even the slightest suspicion that your baby has these symptoms, see a doctor immediately for an examination.

Choanal Atresia, difficulty breathing in the baby, nasal congestion, congenital diseases, respiratory distress, cyanosis, CHARGE syndrome