Congenital posterior nostril atresia may be unilateral or bilateral in onset. The tissue at the atresia can be membranous, bony, or mixed. The incidence of this disease is low and children are prone to complications of congenital malformations in other parts of the body. Such as heart disease, growth retardation, neurological malformations, genital hypoplasia, ear malformations, deafness, and other comorbidities. This child, a female, was 3 years and 10 months old. Open-mouth breathing and congenital deafness were detected after birth. She underwent cochlear implantation at the age of 1 year, after which her hearing improved, but her speech recovery was slow and her articulation was unclear. Afterwards, a nasal exploration followed by nostriloplasty was performed at the local children’s hospital. However, the surgery was not successful. Now, he came to our clinic in order to open the posterior nostril. On examination, we found that the child was breathing with an open mouth, had a constant runny nose, had unclear articulation, and had a speech function that differed greatly from that of other children who had cochlear implants two years later. We performed a transnasal endoscopic opening of the posterior nostril under general anesthesia after completing the examination. During the operation, we found that the left nasal cavity was slightly spacious and the posterior nostrils were obstructed bilaterally. The obstructive structures were bony and covered with mucosa anteriorly and posteriorly. We removed the obstructive bony structures and opened the posterior nostrils bilaterally. The operation went smoothly. Intraoperative bleeding was minimal and no blood transfusion was given. The postoperative follow-up CT showed that the deformed bone blocking the posterior nostril was completely removed and the posterior nostril was completely open. The parents were very happy …… Currently, the child is recovering and can breathe through the mouth and can close his mouth at night. The recovery status of nasal as well as speech function is under close follow-up. The child has to be cleaned up in time for the nasal change during the recent recovery. We arrange a green channel for each short admission and change the medication after sedation. Meanwhile, our otologists and audiologists are closely following the baby’s speech recovery and expect her to be able to speak clearly and fluently soon.