What Is Choanal Atresia? Symptoms, Causes, Diagnosis and Treatment in Newborns
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Choanal atresia is a congenital blockage of the nasal airway caused by extra bone or soft tissue remaining from fetal development. It is rare. [5] When both sides are blocked it is a birth emergency, because newborns breathe almost entirely through the nose. [1] [5] Endoscopic surgical repair is the most common fix, and most babies recover fully. [1] [5]
Key takeaways
Choanal atresia is a congenital condition: babies are born with tissue blocking their nasal airway. [5]
The blockage can be bone or a combination of bone and soft tissue, on one side or both. [5]
It is rare, and most children with it have a blockage on just one side (unilateral). [5]
Older reports suggested the condition was about twice as likely to affect girls [5], but it's now thought to affect both sexes about equally. [6]
Bilateral (both sides) choanal atresia is a birth emergency, since newborns breathe almost entirely through their noses. [1] [5]
One-sided cases may not show symptoms until childhood or even adulthood. [3] [5]
The most common sign of one-sided choanal atresia is nasal drainage on one side that doesn't stop [5].
About half of affected babies are also born with a genetic condition; the most common is CHARGE syndrome. [5]
Surgery is the main treatment; endoscopic repair is the most common approach. [6]
Treatment is usually successful and most babies make a full recovery. [5]
What the research says
Endoscopic repair is now favored, but narrowing can return. A review of contemporary treatment notes that bilateral choanal atresia requires urgent surgery, most practices now favor endoscopic repair, and restenosis requiring revision surgery occurs in as many as 50% of cases. Bioabsorbable, steroid-eluting stents have been adapted for choanal atresia since 2017, and no restenosis or stent-related complications have been reported so far, though the evidence is limited to case series and one case-control study (De Jong et al., Curr Opin Otolaryngol Head Neck Surg, 2024). [1]
Long-term quality of life after repair looks good. In 40 children who had endoscopic repair between 2007 and 2022 (65% bilateral, 60% female, 8 with a syndrome), 84.6% had normal choanae at the last follow-up and the rest had narrowed choanae. Ten children needed revision surgery, most of them with unilateral atresia. Parent-reported quality-of-life scores were similar to those of historical healthy subjects. Children born prematurely had more sinus infections and nasal congestion. This was a single-center study (Rozenblat et al., Am J Rhinol Allergy, 2026). [2]
Recurrences often trace back to incomplete removal of the back of the nasal septum. In a series of 56 patients (25 unilateral, 31 bilateral), 12 repeat surgeries were needed in 10 patients with bilateral atresia because of recurrence, caused by insufficient resection of the posterior vomer and granulation tissue. Function and quality of life improved significantly after surgery in both groups (p < 0.0001). A companion analysis of 34 revision surgeries found that 88% (30/34) of recurrences were due to insufficient vomer resection and 12% (4/34) to granulations. Both studies are retrospective, single-center reports (Yılmaz Topçuoğlu et al., Acta Otolaryngol, 2025; Yılmaz Topçuoğlu et al., J Craniomaxillofac Surg, 2025). [3] [4]
What Is Choanal Atresia?
Choanal atresia (pronounced "ko-UH-nul uh-TREE-zhuh") is a congenital condition where a baby is born with tissue blocking their nasal airway. [5] The blockage may consist of bone or a combination of bone and soft tissue. Choanal atresia can affect one or both sides of your baby's nose. [5]
Blockages or narrowing (a related condition called choanal stenosis) in your child's nasal passages may make it harder for them to breathe. How serious the issue is, and how soon treatment is needed, depends on the extent of the blockage and whether it blocks one or both nasal passages.
Types of Choanal Atresia
Type | What Happens | How Serious |
Unilateral choanal atresia | The blockage affects just one side of the nose, the most common form | Milder; the baby can learn to breathe through one nasal passage, and symptoms may not show up until later childhood or even adulthood |
Bilateral choanal atresia | Blockages affect both nasal passages | A birth emergency; newborns breathe almost entirely through their noses, so they need life-saving emergency care to breathe |
Bilateral choanal atresia is a medical emergency at birth. [1] [5] This is because infants breathe almost entirely through their noses. Typically, babies only breathe through their mouths if they're crying. A provider can insert a small tube into the baby's windpipe (trachea) immediately so they can get air. Once the baby is stable, the provider can perform surgery to permanently correct the problem.
Unilateral choanal atresia is much more common. [5] As these infants can learn to breathe through one nasal passage, symptoms may not show up until later in childhood or even adulthood. [3] [5]
How Common Is Choanal Atresia?
Choanal atresia is rare. Most children with it have unilateral choanal atresia (one side blocked). Older reports suggested the condition was about twice as likely to affect girls as boys, but it's now thought to affect both sexes about equally. [5] [6]
Symptoms of Choanal Atresia
Healthcare providers often recognize symptoms of bilateral choanal atresia at birth. Babies with choanal atresia affecting both sides of their nose have trouble breathing unless they're crying. [5] Their skin and lips may look blue (a condition called cyanosis), and they may be unable to breathe. If this happens, the provider will resuscitate the baby immediately.
Babies that have a blockage in one side of their nose (unilateral choanal atresia) usually have milder symptoms that may not show up until they're home, or even until childhood. Symptoms include:
Symptom | What It Looks Like |
Breathing trouble unless crying | A newborn whose chest sinks in unless they're crying |
Fussy feeding | A newborn that's fussy during feedings; mouth breathing is especially difficult for an infant trying to nurse |
One-sided runny or stuffy nose | Nasal drainage affecting only one side that doesn't stop; the most common sign of choanal atresia |
Long-lasting sinus infections | Chronic sinusitis that keeps coming back |
What Causes Choanal Atresia?
The exact cause of choanal atresia is unknown. Most medical experts believe it happens when the piece of tissue that separates the mouth and nose during fetal development stays intact after a baby is born. [5] In other words, tissue that normally breaks down while the baby develops in the womb remains in place and blocks the nasal airway at birth.
Conditions Associated With Choanal Atresia
About half of the babies with choanal atresia are born with inherited syndromes and genetic disorders associated with other developmental abnormalities. [5] Medical experts don't know why. Associated conditions include:
Associated Syndrome | Notes |
CHARGE syndrome | The most common syndrome linked to choanal atresia |
Treacher Collins syndrome | A genetic disorder affecting facial development |
Crouzon syndrome | A craniofacial condition affecting skull and face growth |
Pfeiffer syndrome | A craniosynostosis syndrome affecting skull shape |
Antley-Bixler syndrome | A rare condition affecting skull and facial bones |
Marshall-Smith syndrome | A rare disorder affecting growth and breathing |
Schinzel-Giedion syndrome | A rare, severe genetic condition |
Complications
Ear problems are common. In one study of 45 children who had surgery for choanal atresia, 19 later developed ear infections that kept coming back or long-lasting fluid in the middle ear, more often if they had CHARGE syndrome or a one-sided blockage. [7] Children with CHARGE syndrome may also have hearing loss, linked to ear and nerve abnormalities that are part of the syndrome. [8]
Children may also struggle to get enough air while eating and aspirate, meaning food goes down their windpipe instead of their esophagus. [5] Your healthcare provider can provide treatment sooner rather than later if they're concerned about these risks.
How Is Choanal Atresia Diagnosed?
Healthcare providers usually diagnose newborns with bilateral choanal atresia while they're still in the hospital. [5] A provider may hold up a laryngeal mirror, the tiny mirror your dentist uses, to your baby's nose to see if they're breathing enough air to fog it up. If the mirror doesn't fog, it suggests the nasal airway is blocked. [5]
If they suspect choanal atresia, they may perform tests:
Test | How It Works |
CT (computed tomography) scan | An imaging test that creates detailed 3D images, showing structural abnormalities or blockages in your baby's nasal passages |
Nasal endoscopy | The provider inserts a thin tube with a small camera (endoscope) into your baby's nose to get a better look at the nasal structures |
Your baby's provider will ensure they're getting the breathing support they need throughout these tests so there aren't any risks.
How Is Choanal Atresia Treated?
Surgery is the main treatment for choanal atresia. [6] If your baby is born with blockages in both nasal passages, they'll need surgery as soon as possible. [1] [5] In some cases, infants with blockages on one side learn to breathe through their mouths, delaying the need for immediate surgery. In that case, you can work to manage symptoms at home.
But eventually, babies and children need choanal atresia repair to improve their health and quality of life. Endoscopic choanal atresia repair is the most common approach. [1] [5]
During the surgery, the surgeon creates a hole through the bone or tissue that's blocking your baby's airway. [5] This can be achieved through the nose (transnasal) or through the roof of the mouth (transpalatal). [6] In some cases, the surgeon may place a stent, a small tube, inside your baby's nasal passage to keep the airway open during healing. [5] The stent is typically removed after 2 to 6 weeks. [6] Surgeons perform choanal atresia repair in an operating room while your baby is under general anesthesia.
Treatment Situation | What Happens |
Bilateral (both sides blocked) | Emergency breathing tube into the windpipe at birth, then surgery as soon as possible |
Unilateral (one side blocked), can breathe and feed | Symptoms managed at home; surgery planned for later |
Surgical repair | Endoscopic repair (most common); blockage removed through the nose or roof of the mouth; a stent may stay in place for 2 to 6 weeks during healing |
At-home management | Saline nasal spray to keep the nasal passages clean |
Managing Symptoms at Home
If your baby has unilateral choanal atresia, you and your child's provider may decide to wait on surgery until they're older. [5] This is fine, as long as your baby doesn't have severe breathing problems or difficulty eating. In the meantime, ask your provider how to properly manage choanal atresia symptoms. For example, you may need to use a saline nasal spray to keep your baby's nasal passages clean. [6]
Outlook and Prognosis
Your healthcare provider will discuss all treatment options with you in detail if your baby is born with choanal atresia. With unilateral choanal atresia, they'll let you know when it's safe to wait on surgery and when delaying poses risks.
Treatment for choanal atresia is usually successful. Most babies make a full recovery after surgery [5].
When Should I Call My Healthcare Provider?
Schedule a visit with a healthcare provider any time you notice changes in the way your baby or child is breathing or eating. Sometimes, choanal atresia symptoms don't surface until later, especially in mild unilateral cases. [5] It's important to get them checked.
What Questions Should I Ask My Healthcare Provider?
To understand your baby's situation and treatment plan, ask your provider:
Does my baby have blockages in one nasal passage or both?
Is my child's condition associated with another syndrome like CHARGE?
When will they need surgery?
What surgical approach do you recommend?
How will we know the surgery was successful?
Living With Choanal Atresia
Learning that your baby has choanal atresia can be scary, especially if they have breathing difficulties at birth. Fortunately, healthcare providers successfully treat this condition with surgery. If you suspect your baby has undiagnosed choanal atresia, call your healthcare provider.
Conclusion
Choanal atresia is a congenital condition where a baby is born with extra tissue blocking their nasal airway, made of bone or a mix of bone and soft tissue. It is rare, thought to affect both sexes about equally, and most often unilateral (one side). When both passages are blocked, it's a birth emergency, since newborns breathe almost entirely through their noses; a tube into the windpipe buys time until surgery. When only one side is blocked, the most common clue is nasal drainage on one side that never stops, sometimes not noticed until childhood or adulthood. Roughly half of affected babies also carry a genetic condition, most often CHARGE syndrome. Surgery, most often an endoscopic repair performed through the nose or the roof of the mouth, sometimes with a temporary stent, is the main treatment, and treatment is usually successful, with most babies making a full recovery.
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Frequently Asked Questions
What is choanal atresia?
Choanal atresia is a congenital condition where a baby is born with tissue blocking their nasal airway, making it harder for them to breathe.
How do you pronounce "choanal atresia"?
Choanal atresia is pronounced "ko-UH-nul uh-TREE-zhuh."
Is choanal atresia something a baby is born with?
Yes. It's a congenital condition, meaning the blockage is present at birth.
What exactly is blocking the airway?
The blockage may consist of bone or a combination of bone and soft tissue.
Can choanal atresia affect both sides of the nose?
Yes. It can affect one side (unilateral) or both sides (bilateral) of the nose.
What is unilateral choanal atresia?
A blockage in just one side of the nose, the most common form.
What is bilateral choanal atresia?
Blockages in both nasal passages, a birth emergency that requires life-saving care immediately.
How common is choanal atresia?
Choanal atresia is rare.
Is choanal atresia more common in girls or boys?
Older reports suggested choanal atresia was twice as common in girls, but it's now thought to affect both sexes about equally.
Can a baby with one blocked nostril breathe normally?
Usually yes. Babies with a one-sided blockage can often learn to breathe through the clear nasal passage.
Why is bilateral choanal atresia an emergency?
Because infants breathe almost entirely through their noses. Typically, babies only breathe through their mouths if they're crying.
What happens right after a baby with bilateral choanal atresia is born?
A provider can insert a small tube into the baby's windpipe (trachea) immediately so they can get air. Once stable, surgery is performed.
What are the signs of bilateral choanal atresia at birth?
The baby has trouble breathing unless crying, and their skin and lips may look blue (cyanosis).
What is cyanosis?
A condition where the skin and lips look blue because of breathing difficulty.
Can choanal atresia go unnoticed at birth?
Yes. One-sided (unilateral) cases often have mild symptoms that don't show up until later childhood or even adulthood.
What is the most common sign of one-sided choanal atresia?
One-sided nasal drainage (a runny or stuffy nose affecting only one side) that doesn't stop.
Can a newborn's chest sink in with choanal atresia?
Yes. One symptom is a newborn whose chest sinks in unless they're crying.
Why do babies with choanal atresia get fussy during feedings?
Mouth breathing is especially difficult for an infant trying to nurse, so a blocked nose makes feeding harder.
Can choanal atresia cause chronic sinusitis?
Yes. Long-lasting sinus infections (chronic sinusitis) are one of the symptoms.
What causes choanal atresia?
The exact cause is unknown, but experts believe tissue that normally separates the mouth and nose during fetal development stays intact after birth.
Does choanal atresia develop before birth?
Yes. Experts believe the blocking tissue fails to break down during fetal development.
Can choanal atresia be prevented?
There's no known way to prevent it since the exact cause is unknown.
What is choanal stenosis?
Narrowing (rather than complete blockage) of the nasal passages, a related condition.
Is choanal atresia linked to genetic syndromes?
About half of affected babies are born with inherited syndromes or genetic disorders.
What is the connection between choanal atresia and CHARGE syndrome?
CHARGE syndrome is the most common genetic condition linked to choanal atresia.
What other syndromes are associated with choanal atresia?
Treacher Collins syndrome, Crouzon syndrome, Pfeiffer syndrome, Antley-Bixler syndrome, Marshall-Smith syndrome, and Schinzel-Giedion syndrome.
Why do experts think the link with syndromes exists?
Medical experts don't know why about half of affected babies have associated genetic conditions.
Can choanal atresia cause ear infections?
Ear problems are common. In one study, 19 of 45 children treated for choanal atresia developed ear infections that kept coming back or long-lasting fluid in the middle ear.
Can choanal atresia cause hearing loss?
Children with CHARGE syndrome, the syndrome most often linked to choanal atresia, may have hearing loss caused by ear and nerve abnormalities.
Can babies with choanal atresia aspirate food?
Yes. They may struggle to get enough air while eating, causing food to go down the windpipe instead of the esophagus.
What is aspiration?
When food goes down the windpipe instead of the esophagus.
How is choanal atresia diagnosed at birth?
Providers may hold a laryngeal mirror (the tiny mirror dentists use) to the baby's nose to see if breathing air fogs it up.
What is a laryngeal mirror test?
A quick check where a small mirror is held to the baby's nostril. If the baby breathes enough air, the mirror fogs up.
What imaging is used to diagnose choanal atresia?
A CT (computed tomography) scan that creates detailed 3D images of the nasal passages.
What does a CT scan show?
Structural abnormalities or blockages in the baby's nasal passages.
What is a nasal endoscopy?
A test where a thin tube with a small camera (endoscope) is inserted into the baby's nose to look at nasal structures.
Are the diagnostic tests safe for a baby with a blocked nose?
Providers ensure the baby gets the breathing support they need throughout testing.
Is surgery the only treatment?
Surgery is the main treatment for choanal atresia.
When does a baby with bilateral choanal atresia need surgery?
As soon as possible, right after emergency care stabilizes their breathing.
Can surgery wait with one-sided choanal atresia?
Yes. Some infants learn to breathe through their mouths, delaying the need for immediate surgery.
What is endoscopic choanal atresia repair?
The most common surgical approach, where the surgeon works through the nose to remove the blockage.
How does the surgeon open the airway?
By creating a hole through the bone or tissue blocking the airway, either through the nose (transnasal) or the roof of the mouth (transpalatal).
What is a stent in choanal atresia surgery?
A small tube placed inside the nasal passage to keep the airway open during healing.
How long does the stent stay in?
The stent is typically removed after 2 to 6 weeks.
Is choanal atresia surgery done under anesthesia?
Yes. The repair is performed in an operating room while the baby is under general anesthesia.
Can symptoms be managed at home while waiting for surgery?
Yes. Ask your provider about using a saline nasal spray to keep your baby's nasal passages clean.
Is it safe to delay surgery for one-sided cases?
Delaying surgery for one-sided cases is fine as long as the baby doesn't have severe breathing problems or difficulty eating. Your provider will advise on timing.
Is choanal atresia treatment successful?
Treatment is usually successful, and most babies make a full recovery after surgery.
What does recovery look like?
Most babies recover fully after the airway is surgically opened.
When should I call my healthcare provider?
Any time you notice changes in the way your baby or child is breathing or eating.
Can symptoms appear later in childhood?
Yes, especially in mild unilateral cases, where symptoms sometimes don't surface until later.
What questions should I ask my provider?
Ask whether the blockage affects one or both passages, whether a syndrome like CHARGE is involved, when surgery is needed, which approach is recommended, and how you'll know the surgery succeeded.
Should I worry if I suspect undiagnosed choanal atresia?
Learning about choanal atresia is scary, but providers successfully treat it with surgery. Call your healthcare provider to get your baby checked.
Related Reading
What Are Birth Defects? Symptoms, Causes, Diagnosis, and Care Explained
Pfeiffer Syndrome: Understanding This Rare Genetic Condition
Cyanosis: Symptoms, Causes, Types, Diagnosis, and Treatment — A Complete Guide
Chronic Sinusitis (Chronic Rhinosinusitis): Symptoms, Causes, and Treatment
Nasal Congestion: Causes, Symptoms, and Effective Relief Strategies
References
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Yılmaz Topçuoğlu MS, Plinkert PK, Federspil PA, Baumann I. Long-term outcome of 56 patients after transnasal endoscopic repair of congenital choanal atresia. Acta Otolaryngol. 2025;145(12):1147-1154. PMID: 41249090. https://doi.org/10.1080/00016489.2025.2561913
Yılmaz Topçuoğlu MS, Schuler PJ, Westhoff JH, Sommerburg O, Baumann I. A recurrence analysis in patients with congenital choanal atresia. J Craniomaxillofac Surg. 2025;53(9):1571-1576. PMID: 40628561. https://doi.org/10.1016/j.jcms.2025.07.003
Cleveland Clinic. Choanal atresia: types, causes & treatment. Cleveland Clinic Health Library. Last updated September 2, 2026. https://my.clevelandclinic.org/health/diseases/21865-choanal-atresia
Andaloro C, Winters R, La Mantia I. Choanal atresia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. PMID: 29939546. https://www.ncbi.nlm.nih.gov/books/NBK507724/
Godse NR, Lu N, Shaffer AD, et al. Long term incidence and outcomes of sinonasal and otologic disease in patients with pyriform aperture stenosis and choanal atresia. J Craniofac Surg. 2022;33(5):1409-1412. PMID: 35275859. https://doi.org/10.1097/SCS.0000000000008604
National Library of Medicine. CHARGE syndrome. MedlinePlus Genetics. Last updated February 1, 2017. https://medlineplus.gov/genetics/condition/charge-syndrome/
Medical disclaimer
This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition, especially concerning pregnancy, infants, or children, or before making decisions about treatment.
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