A neonate presents with biphasic (both inspiratory and expiratory) stridor from birth, worse in prone position, with a normal cry. Flexible nasopharyngoscopy shows posterior displacement of the arytenoids and aryepiglottic folds. Which diagnosis is MOST likely?

• A Laryngomalacia
• B Subglottic hemangioma
• C Subglottic stenosis
• D Bilateral vocal cord paralysis ✓

Explanation

Biphasic stridor (both phases equal) from birth with a normal cry suggests bilateral vocal cord paralysis (the cry is produced by cords that still approximate). Laryngomalacia causes predominantly inspiratory stridor worse in supine position (not prone), with a normal cry in early infancy. Subglottic hemangioma produces expiratory or biphasic stridor but typically presents at 2–6 months. Bilateral cord paralysis may be idiopathic or secondary to Arnold-Chiari malformation requiring MRI of the brain.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.