Choanal atresia is a common cause of congenital nasal obstruction. It is more frequently unilateral in presentation, and always has a variable degree of bony component. Bilateral choanal atresia is a relative emergency due to nasal airway obstruction in neonates who are obligate nasal breathers. Treatment is surgical and is preferably delayed allowing for facial and nasal growth. Transnasal endoscopic with mucosal sparing techniques are gaining more popularity compared to transpalatal approach. The role of stenting, dilation and mitomycin C is controversial.