Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Indian Journal of Otolaryngology and Head & Neck Surgery

18-02-2024 | Choanal Atresia | Original Article

Neonatal Nasal Obstruction: A Comprehensive Analysis of Our 20 Years’ Experience

Authors: Deepa Shivnani, Shruthi Kobal, Mallikarjun Kobal, Gayatri Sasikumar, E. V. Raman

Published in: Indian Journal of Otolaryngology and Head & Neck Surgery

Login to get access

Abstract

Neonates are obligatory nasal breathers hence nasal obstruction is a very important symptom to be evaluated. Although causes can be trivial most of the time, they can be life-threatening in some. Respiratory distress immediately after birth, feeding difficulties, paradoxical cyanosis, and failure to thrive are the most evident symptoms, and determination of unilateral or bilateral involvement guides the rationale for elective or emergency intervention. This study aimed to evaluate the causes, presentation, and management of neonates with nasal obstruction. We collected the data of all the neonates evaluated for nasal obstruction at our hospital over the past 20 years from June 2003 to May 2023 and assessed the strategy of approach for diagnosis and management of those cases. In our study, the commonest cause for neonatal nasal obstruction was found to be choanal atresia and the rarest was iatrogenic. A variety of other causes were also reported. As neonatal nasal obstruction has a multitude of rare causes each carries a unique assessment and treatment plan. History taking and clinical examination are the most important parts of evaluation including endoscopic evaluation in an office-based setup. Imaging studies add to the evaluation of cases of anatomical obstructions and associated anomalies (syndromes). Early diagnosis and swift intervention can be life-saving. The need for follow-up visits and second-stage corrections should be emphasized in getting the best long-term results.
Literature
1.
Valdez TA, Ainsworth T (2012) Neonatal nasal obstruction. American Academy of Pediatrics, pp 109–123
2.
Alvo A, Villarroel G, Sedano C (2021) Neonatal nasal obstruction. Eur Arch Oto-Rhino-Laryngol 278:3605–3611CrossRef
3.
Leboulanger N (2016) Nasal obstruction in children. Eur Ann Otorhinolaryngol Head Neck Dis 133(3):183–186CrossRefPubMed
4.
5.
Gnagi SH, Schraff SA (2013) Nasal obstruction in newborns. Pediatr Clin N Am 60:903–922CrossRef
6.
Wyatt M (2018) Neonatal nasal obstruction. In: Watkinson JC, Clarke RW (eds) Scott-Brown’s Otorhinolaryngology and Head and Neck Surgery, vol 2, 8th edn. CRC Press, Boca Raton, pp 251–259CrossRef
7.
Rajan R, Tunkel DE (2018) Choanal atresia and other neonatal nasal anomalies. Clin Perinatol 45(4):751–767CrossRefPubMed
8.
9.
10.
Brown OE, Pownell P, Manning SC (1996) Choanal atresia: a new anatomic classifcation and clinical management applications. Laryngoscope 106(1l):97–101CrossRefPubMed
11.
Hengerer AS, Brickman TM, Jeyakumar A (2008) Choanal atresia: embryologic analysis and evolution of treatment, a 30-year experience. Laryngoscope 118(5):862–866CrossRefPubMed
12.
Gujrathi CS, Daniel SJ, James AL, Forte V (2004) Management of bilateral choanal atresia in the neonate: an institutional review. Int J Pediatr Otorhinolaryngol 68(4):399–407CrossRefPubMed
13.
14.
Stankiewicz JA (1990) The endoscopic repair of choanal atresia. Otolaryngol Head Neck Surg 103(6):931–937CrossRefPubMed
15.
Ibrahim AA, Magdy EA, Hassab MH (2010) Endoscopic choanoplasty without stenting for congenital choanal atresia repair. Int J Pediatr Otorhinolaryngol 74(2):144–150CrossRefPubMed
16.
Healy GB, McGill T, Jako GJ, Strong MS, Vaughan CW (1978) Management of choanal atresia with the carbon dioxide laser. Ann Otol Rhinol Laryngol 87(5 Pt 1):658–662CrossRefPubMed
17.
Ramsden JD, Campisi P, Forte V (2009) Choanal atresia and choanal stenosis. Otolaryngol Clin North Am 42(2):339–352CrossRefPubMed
18.
Yuan HB, Poon KS, Chan KH, Lee TY, Lin CY (1993) Fatal gas embolism as a complication of Nd-YAG laser surgery during treatment of bilateral choanal stenosis. Int J Pediatr Otorhinolaryngol 27(2):193–199CrossRefPubMed
19.
Newman JR, Harmon P, Shirley WP, Hill JS, Woolley AL, Wiatrak BJ (2013) Operative management of choanal atresia. JAMA Otolaryngol Head Neck Surg 139(1):71–75CrossRefPubMed
20.
Van Den Abbeele T, Francois M, Narcy P (2002) Transnasal endoscopic treatment of choanal atresia without prolonged stenting. Arch Otolaryngol Head Neck Surg 128(8):936–940CrossRefPubMed
21.
Gosepath J, Santamaria VE, Lippert BM, Mann WJ (2007) Forty-one cases of congenital choanal atresia over 26 years—retrospective analysis of outcome and technique. Rhinology 45(2):158–163PubMed
22.
Uzomefuna V, Glynn F, Al-Omari B, Hone S, Russell J (2012) Transnasal endoscopic repair of choanal atresia in a tertiary care centre: a review of outcomes. Int J Pediatr Otorhinolaryngol 76(5):613–617CrossRefPubMed
23.
Cedin AC, Atallah AN, Andriolo RB, Cruz OL, Pignatari SN (2012) Surgery for congenital choanal atresia. Cochrane Database Syst Rev 15(2):CD008993
24.
Vanzieleghem BD, Lemmerling MM, Vermeersch HF, Govaert P, Dhooge I, Meire F, Mortier GR, Leroy J, Kunnen MF (2001) Imaging Studies in the Diagnostic Workup of Neonatal Nasal Obstruction. J Comput Assist Tomogr 25(4):540–549CrossRefPubMed
25.
26.
Shashy RG, Durairaj V, Holmes JM, Hohberger GG, Thompson DM, Kasperbauer JL (2003) Congenital dacryocystocele associated with intranasal cysts: diagnosis and management. Laryngoscope 113(1):37–40CrossRefPubMed
27.
Davies R, Watkins WJ, Kotecha S, Watts P (2018) The presentation, clinical features, complications, and treatment of congenital dacryocystocele. Eye 32(3):522–526CrossRefPubMed
28.
Patel VA, Landis ZC, Ely AL (2018) Endoscopic management of congenital dacryocystocele. Oper Tech Otolaryngol Head Neck Surg 29(2):55–60CrossRef
29.
Zhang Y, Fan Y, Fan J, Cui Y (2019) Selection of surgical intervention for congenital dacryocystocele. Eur J Ophthalmol 29(2):158–164CrossRefPubMed
30.
International Working Group on Constitutional Diseases of Bone. (1998) International nomenclature and classification of osteochondrodysplasias (1997). Am J Med Genet 79:376–82
31.
Seguin JH, Baugh RF, McIntee RA (1993) Airway manifestations of chondrodysplasia punctata. Int J Pediatr Otorhinolaryngol 27:85–90CrossRefPubMed
32.
Hughes GB, Sharpino G, Hunt W, Tucker HM (1980) Management of the congenital midline nasal masses: a review. Head Neck Surg 2:222–233CrossRefPubMed
33.
Ajose-Popoola O, Lin HW, Silvera VM, Teot LA, Madsen JR, Meara JG, Rahbar R (2011) Nasal glioma: prenatal diagnosis and multidisciplinary surgical approach. Skull Base Rep 1(2):83–88CrossRefPubMedPubMedCentral
34.
35.
Woodward PJ, Sohaey R, Kennedy A (2005) A comprehensive review of fetal tumors with pathologic correlation. Radiographics 25:215–242CrossRefPubMed
36.
Anand B, Raman EV, Rakshit SH (2019) Mature nasopharyngeal teratoma in a neonate: case report and a review of literature. Indian J Otolaryngol Head Neck Surg 71(Suppl 3):S1775–S1778CrossRef
37.
Kountakis SE, Minotti AM, Maillard A et al (1994) Teratomas of the head and neck. Am J Otolaryngol 15:292CrossRefPubMed
38.
39.
Arey L (1950) The craniopharyngeal canal reviewed and reinterpreted. Anat Record 106:1–16 ((PMID: 15404751))CrossRef
40.
Olnes SQ, Schwartz RH, Bahadori RS (2000) Diagnosis and management of the newborn and young infant who have nasal obstruction. Pediatr Rev 21(12):416–420CrossRefPubMed
41.
Aykanat A, Çelik HT, Günaydın RÖ, Yiğit Ş (2020) Iatrogenic nasal synechiae in a premature newborn. T J Pediatr 62:505–508
42.
43.
Jatana KR, Oplatek A, Stein M, Phillips G, Kang DR, Elmaraghy CA (2010) Effects of nasal continuous positive airway pressure and cannula use in the neonatal intensive care unit setting. Arch Otolaryngol Head Neck Surg 136(3):287–291CrossRefPubMedPubMedCentral
Metadata
Title
Neonatal Nasal Obstruction: A Comprehensive Analysis of Our 20 Years’ Experience
Authors
Deepa Shivnani
Shruthi Kobal
Mallikarjun Kobal
Gayatri Sasikumar
E. V. Raman
Publication date
18-02-2024
Publisher
Springer India
Published in
Indian Journal of Otolaryngology and Head & Neck Surgery
Print ISSN: 2231-3796
Electronic ISSN: 0973-7707
DOI
https://doi.org/10.1007/s12070-024-04537-7