A national study of choanal atresia in tertiary care centers in Canada – part I: clinical presentation

Journal of Otolaryngology - Head & Neck Surgery - 2021
Josée Paradis1,2, A Dzioba2, Hamdy El-Hakim3, Paul Hong4,5, Frederick K. Kozak6, Lily H. P. Nguyen7,8, Demitri Perera9, Evan J. Propst10, Jennifer Siu10, Monika Wojtera1, Murad Husein1,2
1Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
2Department of Otolaryngology- Head and Neck Surgery, Children’s Hospital at London Health Sciences Centre, London, Canada
3Division of Pediatric Surgery and Otolaryngology Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children’s Hospital, University of Alberta Hospital, Edmonton, Canada
4Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
5IWK Health Centre, Halifax, Canada
6Faculty of Medicine, University of British Columbia, Vancouver, Canada
7Department of Pediatric Surgery, Montreal Children’s Hospital, Montreal, Canada
8Institute for Health Science Education, McGill University, Montreal, Canada
9Faculty of Medicine, University of Queensland, Brisbane, Australia
10Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada.

Tóm tắt

Abstract Background To evaluate the clinical presentation of choanal atresia (CA) in tertiary centers across Canada. Methods Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with CA at a participating center. Results The health charts of 215 patients (59.6% female) with CA were reviewed and included in this study. The mean age of patients at time of CA presentation was 0.4 months (range 0.1 to 7.2 months) for bilateral CA and 37.8 months (range 0.1 to 164.1 months) for unilateral cases. The most common presenting symptoms for bilateral CA in decreasing order were respiratory distress (96.4%), feeding difficulties (68.2%), and rhinorrhea (65.5%), and for unilateral cases in decreasing order were rhinorrhea (92.0%), feeding difficulties (24.7%), and respiratory distress (18.0%). For the majority of patients (73.2%), the obstruction comprised mixed bony and membranous tissue, with only 10.5% presenting with a purely membranous obstruction. Familial history of CA was confirmed in only 3.3% of cases. One half of patients with CA presented with one or more associated anomalies and 30.6% had a syndrome. Conclusions The present investigation is the first national multi-institutional study evaluating the clinical presentation of CA over three decades. The present cohort of CA patients presented with a breadth of co-morbidities with highly variable presentations, with bilateral cases being more severely affected than unilateral cases. Further investigation into hereditary linkages to CA development is warranted. Graphical abstract

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