A term newborn girl has repeated choking and cyanotic spells during feeds that resolve when she cries. Attempts to pass a soft catheter through both nostrils fail at about 3 cm. Which single investigation best confirms the suspected diagnosis?

• A Magnetic resonance imaging of the brain
• B Flexible nasendoscopy under sedation
• C Plain lateral radiograph of the skull
• D Axial CT scan of the nose and nasopharynx with thin sections ✓

Explanation

The picture is bilateral choanal atresia: cyclic cyanosis relieved by crying, plus failure of catheter passage. Axial thin-cut CT after suctioning the nose is the definitive study, showing a bony or membranous plate at the choanae and allowing measurement of the vomer thickness for surgical planning. Indian exam convention accepts bony atresia being the common type, about 90 percent of cases.

Reference: Dhingra, Diseases of Ear, Nose and Throat, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.