Skip to main content

Advertisement

SpringerLink
Log in

Neonatal Nasal Obstruction

  • RHINOLOGY: Nasal Obstruction (JV Nayak, Section Editor)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Neonates are obligate nasal breathers. As a result, they are uniquely suspectable to nasal obstruction, particularly when bilateral, and can present with life-threatening respiratory distress, feeding concerns, or noisy breathing. The differential diagnosis for pediatric nasal obstruction is broad; nasal obstruction in the post-natal period can manifest in different levels of the nasal passageway and vary in laterality and severity.

Recent Finding

Clinicians must be able to quickly identify signs and symptoms, develop an appropriate differential diagnosis, and plan treatment to manage neonatal nasal obstruction. This review will use the newest literature to highlight common causes of neonatal nasal obstruction and discuss the epidemiology, presentation, associated problems, workup, management, and review controversial topics in neonatal obstruction.

Summary

Neonatal nasal obstruction can be congenital; or secondary to neurogenic/neoplastic diseases, infectious processes, foreign bodies, inflammatory processes, or maternal factors; or can be indicative of underlying syndromic diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. •• Alvo A, Villarroel G, Sedano C Neonatal nasal obstruction. Eur Arch Otorhinolaryngol. 2021. https://doi-org.stanford.idm.oclc.org/10.1007/s00405-020-06546-y. This is a recently published review paper that provides a comprehensive overview of the major causes of neonatal nasal obstruction, including choanal atresia, CNPAS, midnasal stenosis, dacryocystocele, and neonatal rhinitis.

  2. Thomas EM, Gibikote S, Panwar JS, Mathew J. Congenital nasal pyriform aperture stenosis: a rare cause of nasal airway obstruction in a neonate. Indian J Radiol Imaging. 2010;20(4):266–268. https://doi.org/10.4103/0971-3026.73539 .

  3. James R. Tate MD and Jonathan Sykes MD. Congenital nasal pyriform aperture stenosis FACS. Oto-laryngol Clin North Am. 2009 Jun;42(3):521–5. https://doi.org/10.1016/j.otc.2009.03.006. PMID: 19486746.

  4. Osovsky M, Aizer-Danon A, Horev G, Sirota L. Congenital pyriform aperture stenosis. Pediatric radiology. 2007 Jan;37(1):97-9. https://doi.org.stanford.idm.oclc.org/10.1007/s00247-006-0342-8.

  5. Brown OE, Manning SC, Myer III CM. Congenital nasal pyriform aperture stenosis. The Laryngoscope. 1989 Jan;99(1):86-91. https://doi.org.stanford.idm.oclc.org/10.1288/00005537-198901000-00016.

  6. Sesenna E, Leporati M, Brevi B, Oretti G, Ferri A. Congenital nasal pyriform aperture stenosis: diagnosis and management. Italian journal of pediatrics. 2012 Dec;38(1):1-5. https://doi.org/10.1186/1824-7288-38-28 .

  7. Hui Y, Friedberg J, Crysdale WS. Congenital nasal pyriform aperture stenosis as a presenting feature of holoprosencephaly. International journal of pediatric otorhinolaryngology. 1995 Mar 1;31(2-3):263-74.

  8. Levison J, Neas K, Wilson M, Cooper P, Wojtulewicz J. Neonatal nasal obstruction and a single maxillary central incisor. Journal of Paediatrics and Child Health. 2005;41:380–381. https://doi.org.laneproxy.stanford.edu/10.1111/j.1440-1754.2005.00639.x.

  9. Van Den Abbeele T, Triglia JM, Fran ̧cois M, Narcy P. Congenital nasal pyriform aperture stenosis: diagnosis and management of 20 cases. Ann Otol Rhinol Laryngol. 2001 Jan;110(1):70–5. https://doi.org/10.1177/000348940111000113. PMID: 11201813.

  10. Esen E, Bayar Muluk N, Altintoprak N, Ipci K, Cingi C. Pyriform aperture enlargement in all aspects. J Laryngol Otol. 2017 Jun;131(6):476–479.  https://doi.org/10.1017/S0022215117000391. Epub 2017 Feb 27. PMID: 28238296.

  11. Lee K-S, Yang C-C, Huang J-K, Chen Y-C, Chang K-C. Congenital pyriform aperture stenosis: surgery and evaluation with three-dimensional computed tomography. Laryngoscope. 2002;112:918–21. https://doi.org/10.1097/00005537-200205000-00025.

    Article  PubMed  Google Scholar 

  12. Lee JJ, Bent JP, Ward RF. Congenital nasal pyriform aperture stenosis: non-surgical management and long-term analysis. International journal of pediatric otorhinolaryngology. 2001 Aug 20;60(2):167-71.

  13. Kevin D. Pereira, Brian S. Wang, Congenital nasal pyriform aperture stenosis, Operative Techniques in Otolaryngology-Head and Neck Surgery. 2005;16(3):194–7.

    Article  Google Scholar 

  14. Olnes SQ, Schwartz RH, Bahadori RS. Diagnosis and management of the newborn and young infant who have nasal obstruction. Pediatr Rev. 2000;21(12):416–20.

    Article  CAS  Google Scholar 

  15. Nathan CO, Seid AB. Neonatal rhinitis. Int J Pediatr Otorhinolaryngol. 1997;39(1):59–65.

  16. Patel VA, Carr MM. Congenital nasal obstruction in infants: a retrospective study and literature review. Int J Pediatr Otorhinolaryngol. 2017;99:78–84.

  17. Paulsson B, et al. Nasal mucosal congestion during the menstrual cycle. J Laryngol Otol. 1997;111(4):337–9.

    Article  CAS  Google Scholar 

  18. Osguthorpe J, Shirley R. Neonatal respiratory distress from rhinitis medicamentosa. Laryngoscope. 1987;97:829–31.

    Article  CAS  Google Scholar 

  19. Harugop AS, Mudhol RS, Hajare PS, et al. Prevalence of nasal septal deviation in new-borns and its precipitating factors: a cross-sectional study. Indian J Otolaryngol Head Neck Surg. 2012;64:248–51.

    Article  Google Scholar 

  20. Lawlor CM, Grant M, Levy J, Ananth A, Guarisco JL. Neonatal nasal septal deviation: two cases of successful early surgical intervention. Ear Nose Throat J. 2017;96(8):E20–3. https://doi.org/10.1177/014556131709600806. PMID: 28846795.

    Article  PubMed  Google Scholar 

  21. Sorri M, Laitakari K, Vainio-Mattila J, Hartikainen-Sorri AL. Immediate correction of congenital nasal deformities; follow-up of 8 years. Int J Pediatr Otorhinolaryngol. 1990;19(3):277–83.

    Article  CAS  Google Scholar 

  22. Elluru RG. Congenital malformations of the nose and nasopharynx. In: Lesperance MM, Flint PW, editors. Cummings pediatric otolaryngology. Philadel- phia: Elsevier Saunders; 2014. p. 134–45.

    Google Scholar 

  23. •• Rajan R, Tunkel DE. Choanal atresia and other neonatal nasal anomalies. Clin Perinatol. 2018;45(4):751-767. https://doi.org/10.1016/j.clp.2018.07.011. Epub 2018 Sep 18. PMID: 30396416. This is a recently published review paper that provides a comprehensive overview of choanal atresia and other neonatal congenital nasal anomalies/deformities, including CNPAS, encephaloceles, gliomas, dermoids, nasolacrimal duct cysts, and neonatal septal deviations.

  24. Cunningham MJ. Endoscopic management of pediatric nasolacrimal anomalies. Otolaryngol Clin North Am. 2006;39(5):1059–74, viii-ix.  https://doi.org/10.1016/j.otc.2006.07.004. PMID: 16982263.

  25. Lueder GT. The association of neonatal dacryocystoceles and infantile dacryocystitis with nasolacrimal duct cysts (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2012;110:74–93.

    PubMed  PubMed Central  Google Scholar 

  26. Hughes GB, Sharpino G, Hunt W, et al. Management of the congenital midline nasal masses: a review. Head Neck Surg. 1980;2:222–33.

    Article  CAS  Google Scholar 

  27. Anderson PJ, Dobson C, Berry RB. Nasal dermoid cysts in siblings. Int J Pediatr Otorhinolaryngol. 1998;44:155–9.

    Article  CAS  Google Scholar 

  28. Tirumandas M, Sharma A, Gbenimacho I, et al. Nasal encephaloceles: a review of etiology, pathophysiol- ogy, clinical presentations, diagnosis, treatment, and complications. Childs Nerv Syst. 2013;29(5):739–44.

    Article  Google Scholar 

  29. Laurence KM, James N, Miller MH, et al. Double-blind randomized controlled trial of folate treatment before conception to prevent recurrence of neural-tube de- fects. Br Med J (Clin Res Ed). 1981;282:1509–11.

    Article  CAS  Google Scholar 

  30. Suurna MV, Maurrasse SE. Congenital nasal anomalies. In: Lalwani AK. eds. Current Diagnosis Treatment Otolaryngology—Head and Neck Surgery, 4e. McGraw-Hill. April 24, 2021. Accessed: https://accesssurgery-mhmedical-com.laneproxy.stanford.edu/content.aspx?bookid=2744sectionid=229671450

  31. Zapata S, Kearns DB. Nasal dermoids. Curr Opin Otolaryngol Head Neck Surg. 2006;14:406–11.

    Article  Google Scholar 

  32. Bradley PJ, Singh SD. Nasal glioma. J Laryngol Otol. 1965;99:247.

    Article  Google Scholar 

  33. Blumenfeld R, Skolnik EM. Intranasal encephaloceles. Arch Otolaryngol. 1965;82:527–31.

    Article  CAS  Google Scholar 

  34. Hedlund G. Congenital frontonasal masses: developmental anatomy, malforma- tions, and MR imaging. Pediatr Radiol. 2006;36:647–62.

    Article  Google Scholar 

  35. Andaloro C, La Mantia I. Choanal Atresia. Updated 2020 Sep 27. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507724/ .

  36. Brown OE, Pownell P, Manning SC. Choanal atresia: a new anatomic classification and clinical manage- ment applications. Laryngoscope. 1996;106(1 Pt 1):97–101. https://doi.org/10.1097/00005537-199601000-00019. PMID:8544637.

    Article  CAS  Google Scholar 

  37. Burrow TA, Saal HM, de Alarcon A, Martin LJ, Cotton RT, Hopkin RJ. Characterization of congenital anomalies in individuals with choanal atresia. Arch Otolaryngol Head Neck Surg. 2009;135(6):543–7. https://doi.org/10.1001/archoto.2009.53.

    Article  PubMed  Google Scholar 

  38. Dupe V, Matt N, Garnier JM, Chambon P, Mark M, Ghyselinck NB. A newborn lethal defect due to inactivation of retinaldehyde dehydrogenase type 3 is prevented by maternal retinoic acid treatment. Proc Natl Acad Sci U S A. 2003;100(24):14036–41. https://doi.org/10.1073/pnas.2336223100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Asher BF, McGill TJI, Kaplan L, Friedman EM, Healy GB. Airway complications in CHARGE association. Arch Otolaryngol Head Neck Surg. 1990;116(5):594–5. https://doi.org/10.1001/archotol.1990.01870050094014.

    Article  CAS  PubMed  Google Scholar 

  40. Park AH, Brockenbrough J, Stankiewicz J. Endoscopic versus traditional approaches to choanal atresia. Otolaryngol Clin North Am. 2000;33:77–90.

  41. Bedwell JR, Choi SS. Are stents necessary after choanal atresia repair? Laryngoscope. 2012;122(11):2365–6. https://doi.org/10.1002/lary.23381.

    Article  PubMed  Google Scholar 

  42. Kwong KM. Current updates on choanal atresia. Front Pediatr. 2015;3(52):1–7.

    Google Scholar 

  43. Durmaz A, Tosun F, Yldrm N, Sahan M, Kvrakdal C, Gerek M. Transnasal endoscopic repair of choanal atresia: results of 13 cases and meta-analysis. J Craniofac Surg. 2008;19(5):1270–4. https://doi.org/10.1097/SCS.0b013e3181843564.

    Article  PubMed  Google Scholar 

  44. Schoem SR. Transnasal endoscopic repair of choanal atresia: why stent? Otolaryngol Head Neck Surg. 2004;131(4):362–6. https://doi.org/10.1016/j.otohns.2004.03.036.

    Article  PubMed  Google Scholar 

  45. Kubba H, Bennett A, Bailey CM. An update on choanal atresia surgery at Great Ormond Street Hospital for Children: preliminary results with mitomycin C and the KTP laser. Int J Pediatr Otorhinolaryngol. 2004;68(7):939–45. https://doi.org/10.1016/j.ijporl.2004.02.010.

    Article  PubMed  Google Scholar 

  46. Uzomefuna V, Glynn F, Al-Omari B, Hone S, Russell J. Transnasal endoscopic repair of choanal atresia in a tertiary care centre: a review of outcomes. Int J Pediatr Otorhinolaryngol. 2012;76(5):613–7. https://doi.org/10.1016/j.ijporl.2012.01.033.

    Article  PubMed  Google Scholar 

  47. Carter JM, Lawlor C, Guarisco JL. The efficacy of mitomycin and stenting in choanal atresia repair: a 20 year experience. Int J Pediatr Otorhinolaryngol. 2014;78(2):307–11. https://doi.org/10.1016/j.ijporl.2013.11.031.

    Article  Google Scholar 

  48. Ben Salem D, Duvillard C, Assous D, et al. Imaging of nasopharyngeal cysts and bursae. Eur Radiol. 2006;16:2249–2258. https://doi-org.laneproxy.stanford.edu/10.1007/s00330-006-0238-x

  49. Kountakis SE, Minotti AM, Maillard A, Stiernberg CM. Teratomas of the head and neck. American journal of otolaryngology. 1994 Jul 1;15(4):292-6.

  50. • Smith MM, Ishman SL. Pediatric nasal obstruction. Otolaryngol Clin North Am. 2018;51(5):971–85. https://doi.org/10.1016/j.otc.2018.05.005. This review paper provides a thorough overview of common causes of neonatal nasal obstruction with superb illustrations and CT/MRI figures for various conditions.

    Article  PubMed  Google Scholar 

  51. Alexander VR, Manjaly JG, Pepper CM, et al. Head and neck teratomas in children–a series of 23 cases at Great Ormond Street Hospital Int. J Pediatr Otorhinolaryngol. 2015;79:2008–2014.

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gnagi SH, Schraff SA. Nasal obstruction in newborns. Pediatric Clinics. 2013 Aug 1;60(4):903-22. https://doi.org/10.1016/j.pcl.2013.04.007. Epub 2013 Jul 3. PMID: 23905827.

Download references

Author information

Authors and Affiliations

  1. Dept. Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road/Stanford, San Francisco, CA, 94305, USA

    Mohamed Diop & Karthik Balakrishnan

Authors
  1. Mohamed Diop
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karthik Balakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed Diop.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical collection on RHINOLOGY: Nasal Obstruction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Diop, M., Balakrishnan, K. Neonatal Nasal Obstruction. Curr Otorhinolaryngol Rep 9, 389–398 (2021). https://doi.org/10.1007/s40136-021-00375-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40136-021-00375-1

Keywords

Search

Navigation