# Choanal Narrowing in Children With Down Syndrome: A Retrospective Case Series

## TL;DR

Children with Down syndrome may be more likely to have choanal narrowing, and surgical repair can improve breathing and sleep apnea symptoms.

## Contribution

This study highlights the under-recognized prevalence of choanal narrowing in children with Down syndrome and its successful treatment.

## Key findings

- 15.5% of children undergoing choanal narrowing repair had Down syndrome, much higher than the general population.
- Surgical repair improved nasal breathing and sleep apnea symptoms in most patients with Down syndrome.
- Only one patient required revision surgery for restenosis.

## Abstract

A retrospective case series was conducted on pediatric patients with Down syndrome who underwent choanal narrowing repair at a tertiary pediatric center between May 2017 and July 2024. Of the 84 patients who underwent repair, 13 children with Down syndrome (mean age: 2.54 years) were identified, representing 15.5% of the cohort. All had choanal narrowing (30%-80% stenosis, mean: 62%) and underwent concurrent airway procedures including adenoidectomy (n = 9), turbinate reduction (n = 7), and adenotonsillectomy (n = 3). Caregivers reported improvement in nasal breathing and obstructive sleep apnea (OSA) symptoms in all patients and improvement in snoring in 12 of 13 (92%) patients. One patient (8%) required revision surgery for restenosis. Children with Down syndrome represented a substantial proportion (15.5%) of those undergoing choanal narrowing repair, compared to ~0.2% prevalence in the general population. These findings suggest choanal narrowing may be more common in Down syndrome than previously recognized and should be considered when evaluating airway obstruction in this population. Prospective studies using objective outcome measures are needed.