Choanal Atresia: Bilateral

What is bilateral choanal atresia?

Choanal atresia (say: co-ANN-ul ah-TREE-zee-ah) is a condition in which the back of the nasal passage is blocked by bone or soft tissue. The nasal passage is the route that brings air through the nose to the throat. Choanal atresia is present at birth. Some babies have a blocked nasal passage on one side (unilateral) and some babies have both sides blocked (bilateral).

Choanal Atresia
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Choanal atresia is a condition in which the back of the nasal passage is blocked by bone or soft tissue. Some babies have a blocked nasal passage on one side.

Babies cannot breathe well through their mouths for the first 3 to 6 months of life, so a baby with bilateral choanal atresia will need surgery (an operation) as soon as possible.

During the operation, the nasal passage is opened. Small plastic tubes called nasal stents are placed in each nostril to keep the nasal passage open while it is healing. Your baby will be able to breathe through these tubes. The tubes also keep the nasal passages open while the area is healing.

An otolaryngologist/head and neck surgeon (ear nose and throat doctor) will do the surgery.

This page explains what to expect when your baby is having surgery for bilateral choanal atresia and how to take care of your baby after the operation.

Getting ready for the operation

Several hours before the operation, your baby will need to stop eating and drinking. The doctor or nurse will tell you when your baby must stop eating and drinking.

Important information

Date and time of the operation:

When you must stop feeding your baby:

Other things to remember:

Your baby's otolaryngology (ENT) doctor:

The doctor's phone number:

The otolaryngology (ENT) clinic nurse's number:

Your family doctor's number:

What happens during the operation

Before the operation starts, your baby will have a special "sleep medicine" called a general anaesthetic. This means your baby will sleep through the operation and will not feel any pain.

During the operation, the nasal passage is opened. Small plastic tubes called nasal stents are placed in each nostril to keep the nasal passage open while it is healing.

The operation usually takes from 1 to 2 hours.

After the operation

You will be able to see your baby as soon as he or she is fully awake. A volunteer from the Surgical Waiting Room will bring you to see your baby.

Your baby will probably be in the hospital for 7 to 10 days

After the operation, your baby will spend up to 4 hours in the recovery room, also called the Post Anaesthetic Care Unit (PACU). Your baby will then be transferred to a room on the Otolaryngology (ENT) inpatient unit. This room is called the constant observation room and has a nurse in it at all times.

  • Your baby will be on a monitor that helps the nurse watch your baby’s breathing.
  • Your baby will have an IV tube in place until he or she is drinking and no longer needs IV medication.
  • Your baby's nurse will tell you when your child can start drinking from the bottle or the breast.
  • Your baby may sometimes have some pinkish-red mucus (sticky fluid) in his nasal stents or nostril. The nurses will suction this mucus with a narrow plastic tube. It will turn to a clear or white colour in a few days.
  • You can sleep overnight in your baby’s room.
  • If your baby has pain after the operation, the doctor or nurse will give him or her pain medicine, either through the intravenous (IV) tube in the arm or as a liquid to swallow.

If your baby has other medical conditions, your otolaryngology doctor will discuss this with you.

A nurse will teach you how to care for your baby at home

Your baby’s nurses, a Transitional Care Coordinator (TCC), and/or a Community Care Access Centre (CCAC) worker together will help you obtain all the supplies, equipment, and support that you will need at home. The nurses will teach you how to care for your baby at home.

  • A nurse will teach you and another family caregiver how to assess how well your baby is breathing through the stents, and the signs and symptoms of respiratory distress. Respiratory distress means your baby is not breathing well.
  • You will also be taught how to suction the nasal stents so that they do not get blocked up. Before your baby goes home, nurses will help you practice until you are comfortable suctioning your baby's nasal stents.
  • A nurse will show you how to clean your baby’s nose and how to give your baby nose drops.
  • You and the other family caregiver will be required to get your cardio pulmonary resuscitation (CPR) certification. Someone at the hospital will help you arrange this.

When you feel confident with suctioning and the otolaryngology doctor says it is okay, you will be able to take your baby off the unit. You will need to take the suctioning equipment with you.

Before your baby is discharged home, a “Care by Parent Overnight Stay” will be arranged for you. This means that you and the other family caregiver can stay in a room on the unit, with your baby. You will do all the care for your baby that night. A nurse will be available as a resource person. This is to help you become more confident and independent in taking care of your child. It will also help you make decisions on how to set up your home.

Caring for your baby at home

Follow these intructions when your baby goes home after the procedure.

Keep your baby's nasal passages clear

Keep your baby's nasal passages clear as instructed by your nurses.

Give your baby nose drops

Your baby's nurse will give you a prescription for antibiotic nose drops before you leave the hospital. Remember to place the drops into the nasal passage around the stent. Do not put the drops into the stents.

Feed your baby

Your baby can go back to his normal diet. Remember, make sure your baby's nasal passages are clear before starting to feed.

You may give your baby medicine for pain

You may receive a prescription for pain medication before you leave the hospital. Follow the dosage instructions given to you by the pharmacist. Although these prescription pain medications can be beneficial, they are also potentially very dangerous, if not used properly.

When using these medications, if you notice any change in either breathing or level of drowsiness that concern you, stop the medication and seek medical attention. If your child is unresponsive, call 911 immediately.

Do not give your child over-the-counter medicine, that may have a sedative effect (makes people sleep) while giving the prescription pain medicine. Examples of these medicines are decongestants and antihistamines. Discuss these medications with your pharmacist.

You may give your child acetaminophen (such as Tylenol or Tempra) if he has pain. Give the dose as printed on the bottle for your child's age. Do not give your child ibuprofen (Motrin, Advil, or Midol) or ASA (Aspirin) for two weeks after the surgery. These medications could increase your child's risk of bleeding after the operation. Check with the nurse or doctor first before giving these medicines to your child.

Help your baby breathe more comfortably

You can use a machine called a humidifer to help your baby breathe more comfortably. A humidifer makes the air moist by creating a cool mist. This helps keep the mucus in your baby's nasal stents loose, so it does not become sticky and block them. Put the humidifier beside your baby’s bed.

Bathing

Your baby can have baths. Make sure to keep tub water out of your baby's nose.

Make sure everyone who looks after your baby knows how to take care of him

Do not leave your baby with anyone who does not know how to take care of your baby safely. This includes:

  • knowing the signs and symptoms of respiratory distress
  • suctioning the nasal stents
  • CPR training

Your baby will need to wear the stents for about 3 months

Nasal stents are usually left in the nasal passages for about 3 months. When ready, they will be removed in the hospital. Your baby will need a general anaesthetic.

Your otolaryngology doctor will tell you when he will need to see your baby again. The otolaryngology unit will tell you the date and time for a follow-up appointment.

When to call the doctor

Please call your baby’s otolaryngology doctor, the otolaryngology clinic, or your family doctor right away if your baby has any of the following signs after going home.

  • yellowish or green nasal discharge
  • bleeding from the nose or mouth
  • fever of 38.5°C (101°F) or higher
  • the stents fall out
  • pain that gets worse
  • vomiting (throwing up) that does not stop
  • swelling of the nose or face
  • difficulty swallowing
  • difficulty breathing 

If this is an emergency, do not wait. Take your baby to the closest emergency department.

Making sure your baby is safe

Only leave your baby with people that know how to take care of your baby safely. This includes:

  • knowing the signs and symptoms of respiratory distress
  • suctioning the nasal stents
  • CPR training

Key points

  • In bilateral choanal atresia, the nasal passage is blocked by bone or soft tissue on both sides of the nose. Your baby will need an operation to help him breathe.
  • During surgery, the nasal passage is opened, and small plastic tubes, called nasal stents are placed in each nostril to keep the nasal passage open while it is healing.
  • A nurse will show you how to give your baby nose drops and suction the nasal passage.
  • It is important for you and anyone who is spending time with your baby to know the signs and symptoms of respiratory distress, how to suction the nasal stents, and be trained in CPR.

Rafat Saleemi, RN, MN

Megan Bunch RN, BScN

Pauline Lackey, RN

Tomka George, RN

Vito Forte, MD, FRCSC

5/7/2010

 





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