Choanal atresia: a twenty-year review of medical comorbidities and surgical outcomes.

OBJECTIVE

To review medical comorbid conditions and surgical outcomes for children treated for choanal atresia (CA).

STUDY

DESIGN

Retrospective review (1979-1998).

METHODS

Participants included 78 children, aged newborn to 18 years, in the setting of an academic pediatric hospital. Main outcome measures were type and number of procedures and airway patency.

RESULTS

Seventy-eight children (48 female and 30 male patients) were treated and followed for CA, with an average follow-up of 35 months. Thirty-five children (45%) had unilateral CA, and 43 children (55%) had bilateral CA. There was no statistically significant sex difference between unilateral and bilateral CA. Concomitant medical problems were common, mostly otitis media with effusion (32%), upper and lower airway diseases (32% and 23%, respectively), cardiac anomalies (19%), and gastrointestinal tract disorders (18%). Statistically significant correlations were found for bilateral CA and cardiac disorders (P =.04), CHARGE syndrome ( P=.002), obstructive sleep apnea ( P=.003), hematological problems (P =.001), and prematurity or failure to thrive (P =.006). Surgery was effective in establishing a patent airway in all cases. Average ages at first surgery were 25.2 months for unilateral and 2.4 months for bilateral CA. Unilateral CA required, on average, 2.7 total procedures, including dilation and removal of stents, compared with bilateral CA, which required 4.9 procedures. Nearly all children underwent correction by means of the transnasal approach.

CONCLUSIONS

To the knowledge of the authors, the present report encompasses the largest series of children treated for CA. The high incidence of comorbid conditions mandates thorough medical evaluation, particularly for otological, airway, cardiac, and gastrointestinal tract diseases.