Choanal atresia:

Noninvasive ways to assess patency of the nares

Classically, to assess patency of the nares in babies with evidence of upper airway obstruction, attempts were made to pass a catheter through the nares. However, catheter passage results in trauma to the nasal airway which can result in mucosal swelling and nasal obstruction in babies without choanal atresia. Noninvasive means of assessing nasal patency are as effective, less traumatic, and preferred.

1. Manually occluding one naris while the baby’s mouth is closed will result in severe retractions and respiratory distress if the remaining naris is not patent.
2. Placing a wisp of cotton on a Q-tip below each naris will reveal gentle movement of the cotton wisp with inspiration and expiration if air flow is occurring through the naris.
3. Placing a small mirror beneath the baby’s nose will reveal spots of condensation below each naris as the baby exhales if the nares are patent.