In a neonate with stridor present at rest that worsens with agitation and feeding, associated with a 'crowing' inspiratory noise but normal cry, the most likely diagnosis is:
- A Bilateral vocal cord palsy
- B Laryngomalacia ✓
- C Subglottic stenosis
- D Vascular ring
Correct answer: B. Laryngomalacia
Explanation
Laryngomalacia is the most common cause of stridor in neonates and infants. It presents with inspiratory stridor beginning in the first few weeks of life, worsening when supine, agitated or feeding, and improving when prone or calm. The cry is normal (vocal cords are unaffected). The epiglottis is omega-shaped and the aryepiglottic folds are shortened, causing inspiratory collapse. Bilateral vocal cord palsy causes a weak/aphonic cry. Subglottic stenosis causes a biphasic stridor often worse when intercurrent URTI occurs.
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.