Choanal atresia repair in Europe and the world – a comprehensive investigation of the current state of care

PURPOSE: Management of patients with choanal atresia (CA) involves various aspects. While a recent study revealed variability in CA management practices across German Ear, Nose, Throat (ENT) departments, the actual current state of care in Europe and worldwide remains to be elucidated, which was the aim of this study. METHODS: An online survey was conducted on preoperative diagnostics, surgical procedures, and postoperative care in CA patients. A total of 116 ENT departments from 46 countries and six continents participated. RESULTS: The median number of CA repairs performed annually across all continents was three. Unilateral CA repair was performed by 64% of ENT departments in patients under five years and by 30% in patients over five years. Preoperative hearing tests were not standard (19%). Computed tomography (CT) was often performed (84%). Endoscopic transnasal CA repair was the main approach (81%). The posterior vomer was routinely resected by 57% of participants. Stents were always or mostly used by 33%. Saline irrigations (77%), topical corticosteroids (37%), and perioperative antibiotics (32%) were recommended as postoperative nasal care measures. Recurrences were attributed to scarring (71%), granulation tissue (40%), and insufficient vomer resections (21%). CONCLUSION: While some practices align with existing recommendations, other aspects require further discussion. The age at which patients should undergo unilateral CA repair still needs clarification. Preoperative hearing tests were not commonly implemented. CT imaging was widely used despite the associated radiation exposure. Over half of the participants resected the posterior vomer. The use of stents and perioperative antibiotics should be discussed further.