Introduction
Choanal atresia (CA) is characterized by anatomical closure of the choanae in the nasal cavity. This is a relatively uncommon disease with an estimated incidence of 1:5000–7000 births. Post-operative restenosis is a common complication following the endoscopic CA repair. Nasopharyngeal reflux and gastroesophageal reflux are the known risk factors for restenosis.
Aim
To evaluate the efficacy of proton pump inhibitors (PPIs) in healing after choanal atresia repair and to compare the results in these patients vs. the patients who did not receive post-operative PPIs after the same surgery.
Patient Profile
- Patients with bilateral bony choanal atresia who underwent the choanal atresia repair surgery (n=40)
Methods
Study design
- A randomized clinical trial
Post-operative Care
- Following the surgery patients were randomized to receive:
- Group 1: Post-operative PPI (esomeprazole) given for 6-weeks; dose:10 mg/day for patients aged ≥1 year or 0.5 mg/kg for patients aged less than 1 year.
- Group 2: No PPI given (Control group)
Results
- Age of the study population ranged from 3 days to 1 month. Of the entire study population, 65% (n=26) were females and 35% (n=14) were males.
- Significantly fewer patients treated with PPI vs. those not treated with PPI (control group) experienced restenosis (Fig. 1).
Fig. 1: Proportion of patients experiencing restenosis
- The percentage of choanal restenosis was significantly less in the PPI vs. the control group (Table 1).
Table 1: Percentage of restenosis in the study groups
|
|
PPI Group (%) |
Control Group |
|
Atresia |
10% |
40% |
|
No atresia |
90% |
60% |
- Age of the patients was comparable in both the study groups and the incidence of restenosis did not correlate with age at the time of surgery.
Conclusion
- Use of Esomeprazole, a PPI decreased the incidence of choanal restenosis by preventing inflammation on choanal mucosa which can enhance good healing mechanism.
- Esomeprazole should be considered as an anti-reflux agent, in postoperative treatment of choanal atresia repair.
Egypt J Otolaryngol. 2022: 38-44.