Choanal Atresia
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Luriko Ozeki
Oct 9, 2015, 10:27:26 AM10/9/15
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Hello colleagues, has anyone ever had experience with choanal atresia? It's a condition where an infant is born with the nasal membrane closed deep in the nasal passage, blocking complete breathing through that particular nostril. (From the outside, the nose looks completely formed and normal.) It's around 6-7 weeks en utero that the nose "falls in" and allows for the membrane to break down for two fully opened nostrils to form. This didn't happen to my 4mo patient who is coming in next week. My question is, might OM be able to either help break down the membrane so it actually opens up so patient can avoid surgery or,--- b/c this is a condition that requires surgery from an allopathic perspective -- prevent the reformation of the membrane post-surgery? The mother is willing to wait to do the surgery if I can help break down the membrane with OM. If that is the case, how aggressive of a treatment protocol and how long might it take to do this? Surgery is currently scheduled for 10/20 but she is willing to push back if we can make inroads with the membrane. My first visit with patient is next Monday so I am doing all the research I can on this. Would points be about "opening the nose" and supporting the KD and LU system? Would herbs be something like bi yan pian or te xiao bi min gan wan to literally open up the sinuses? Or is it more blood movers or KD support? What about doing castor oil packs around the neck? Might that help? Even if you don't have experience with this particular condition, if you have experience in something similar, I'd love your input and feedback. TIA.
Luriko
Board Licensed Adult and Pediatric Acupuncturist
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Efrem Korngold
Oct 9, 2015, 1:47:23 PM10/9/15
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Luriko,
I don’t have any experience treating this congenital problem. However, sometimes acupuncture can activate a developmental process that, for one reason or another, was halted before it was fully completed. Theoretically, the Kidney governs all of these processes, so treating the kidney is fundamental. Consider UB 23, Ki 3, TB 4 (TB is the source of yuan qi for the Kidney), Ki 6 + UB 2 on the affected side (part of the Yin Jiao Mai that goes to the eye and the sinus and nose), LI 4 (opposite side) and LI 20 (same side). Of course, you don’t need to do all these points at once, but alternate. Probably best to treat the child 2-3 times/week if feasible. 6-12 sessions should reveal whether or not you’re achieving the desired result.
Tina Chin-Kaplan
Oct 9, 2015, 6:08:55 PM10/9/15
to Efrem Korngold, Luriko Ozeki, chinese-medic...@googlegroups.com
If you go with herbs, I'd recommend something simpler like cang er zi wan. It worked like a charm for my son as he always had congested sinuses when a tooth came in. Wet 1 teapill in formula or breastmilk for 15-30 mins until soft then use mortar and pestle to make a slurry. Add it to more breastmilk or formula and give it to baby. Do BID.
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Tina Chin-Kaplan, M.S., L.Ac.
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Stephen Cowan
Oct 9, 2015, 6:31:15 PM10/9/15
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Luriko, I am assuming this is unilateral....because I have had babies w partial bilateral choanal atresia that is very serious.....so hopefully feeding is not compromised here....remember, babies are obbligate nose breathers.....
anyway from an embryologic perspective, this part of the upper palate forms around 4 weeks from cells migrating from the neural crest.....these ectoderm cells move towards the nasal pits that are just beginning to form...so this is one of the places where endoderm (the tube) meets the ectoderm....
this relates to the triple burner and the eight extraordinary vessels.....
Efrem and I have taught about the Donut: "the inside of the inside" and the "outside of the outside" and this part of the nose along with the mouth and anus are key places where they meet....in choanal atresia the membrane that represents their meeting doesnt fully involute leaving a membrane that blocks the back of the nose where it joins the pharynx.....
so we want to activate the natural developmental intention....which is a very "ming" thing to do....
I think along with Efrem's considerations, you might want to consider having mom massage LI 20 with very dilute essential oils you can dilute with olive oil.......several times a day
if we consider when this occurred (first 4 weeks of gestation) then I would consider alternating Du-Ren treatments.....one of the oils I use to activate Du is Cedarwood. very aromatic and jing-stimulating....
and one of the high quality companies I've been using lately that's really good is "young living"....
you can place the dilute oil on the points, and do some tuina vibration on Si3/ B62, lu7/k6
you can also put it in an infuser....
remember, also that choanal atresia can be associated with other congenital abnormalities....heart, developmental, and a multisystem disorder called CHARGE syndrome that I've treated in the past.....so I would def use Grow and Thrive now....
let us know how it works....
steve
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Stephen Cowan MD, FAAP
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Efrem Korngold
Oct 9, 2015, 6:41:01 PM10/9/15
to Stephen Cowan, Luriko Ozeki, chinese-medic...@googlegroups.com
Yes, definitely Grow and Thrive! Why didn’t I think of that? :))
Tuning fork stimulation is good, but I believe that needle treatment will be more effective. Massaging the affected areas with essential oils sounds like a good adjunct.
Luriko Ozeki
Oct 9, 2015, 7:19:57 PM10/9/15
to Efrem Korngold, chinese-medic...@googlegroups.com
Thank you Efrem and Tina, both of your suggestions are very helpful and feel I can offer more now!
Board Licensed Adult and Pediatric Acupuncturist
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On Fri, Oct 9, 2015 at 10:47 AM, Efrem Korngold <ef...@thechinadoc.com> wrote:
Luriko Ozeki
Oct 12, 2015, 4:48:14 PM10/12/15
to Efrem Korngold, chinese-medic...@googlegroups.com
I somehow missed Stephen's reply until now, thank goodness I went back to read this thread. Thank you Stephen for your input and thorough explanation of the evolution (or lack there of) of this condition as well. I see now it is indeed a very jing thing.
Yes, the mother contacted me now than later because the baby all of a sudden has had difficulty breathing through the nose at night. From about 4 weeks ago (if memory is correct as this was over the phone), baby is having difficulty breathing at night, so stays up crying and unable to breathe. A lot of phlegm formation and general inflammation in the nose at night. Prior to this, no issues of this at night. This occurrence hastened the mother's contact to the ped and they suggested the surgery on 10/20.
Yes, it is unilateral condition.
After thinking more about this condition, I was also thinking Grow and Thrive, so I'm glad you and Efrem concur.
Just to be clear, Cedarwood diluted on LI20 but tuning fork or acup on S13/UB62 OR LU7/K6, right?
Thank you again Stephen for your input. I'll be seeing the family this afternoon. Will keep you posted.
Best,
Luriko
Board Licensed Adult and Pediatric Acupuncturist
This transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended for the use of the above named person(s) only. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Thank you for your consideration.
Stephen Cowan
Oct 12, 2015, 5:11:47 PM10/12/15
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right....although I suspect its going to take much longer to reverse a congenital condition like this, to charge up the Du, than a few weeks, so more than likely they will do surgery....but its definitely worth a try....I have certainly needled LI20 in little babies for immediate relief but I really want mom to massage that and lu/sp/ki source points and Du and ren points-
hope it helps....
s
Luriko Ozeki
Oct 12, 2015, 6:22:02 PM10/12/15
to Stephen Cowan, Efrem Korngold, chinese-medic...@googlegroups.com
Roger that, Stephen and will emphasize with mom the massaging.
Board Licensed Adult and Pediatric Acupuncturist
Oriental Medicine
Shonishin & Acupuncture
Chinese Herbs
Nutrition
Tel: 424.248.5576
Fax: 310.914.9031
This transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended for the use of the above named person(s) only. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Thank you for your consideration.
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