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Neonatal nasal obstruction

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Abstract

Purpose

Congenital nasal obstruction can be a significant cause of respiratory distress in the newborn, given that they are considered to be obligate nasal breathers. Several different causes have been described, which can be broadly classified as anatomical/malformative, non-tumoral masses and cysts, benign and malignant neoplasia, inflammatory/infectious, traumatic/iatrogenic, and miscellaneous. The purpose of this review is to provide updated and useful clinical information for teams involved in neonatal care, especially in a hospital setting.

Methods

A review of the available literature was performed. Studies were sourced from PubMed with searching of relevant headings and sub-headings and cross-referencing.

Results

The most common etiology is inflammatory, which can have different precipitating factors or be idiopathic, a condition known as neonatal rhinitis. On the other hand, some less frequent but nonetheless relevant conditions causing severe nasal obstruction include choanal atresia, midnasal stenosis, and pyriform aperture stenosis. Some cystic lesions, such as dacryocystoceles with intranasal mucocele, can also produce significant obstruction. Diagnosis usually requires a nasal endoscopy and in some cases imaging such as computed tomography. Management includes different medical and surgical strategies and will greatly depend on the etiology and the severity of symptoms.

Conclusion

Congenital nasal obstruction can be a significant cause of respiratory distress in the newborn. The wide spectrum of differential diagnoses requires a thorough knowledge of nasal anatomy, physiology, and pathology; as well as different management strategies.

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Acknowledgements

We would like to thank Mr. Graeme van der Meer, pediatric otolaryngologist at Starship Children’s Hospital (Auckland, New Zealand) for revising this article.

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Correspondence to Andrés Alvo.

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Alvo, A., Villarroel, G. & Sedano, C. Neonatal nasal obstruction. Eur Arch Otorhinolaryngol 278, 3605–3611 (2021). https://doi.org/10.1007/s00405-020-06546-y

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