A term newborn has repeated cyanotic spells during feeding that improve when the baby cries. Attempts to pass a 6 French catheter through either nostril fail beyond 3 cm. What is the most likely diagnosis?

• A Bilateral choanal atresia ✓
• B Tracheo-oesophageal fistula
• C Laryngomalacia
• D Congenital nasal pyriform aperture stenosis

Explanation

Neonates are obligate nasal breathers, so bilateral choanal atresia produces cyclical cyanosis aggravated by feeding and relieved by crying, which opens the mouth for breathing. Failure to pass a catheter more than about 3.2 cm from the alar rim confirms obstruction at the choana. Pyriform aperture stenosis also blocks the anterior nose but presents with a single midline nostril obstruction pattern and a bony ridge on CT; the classic cry-relieved spells point to choanal atresia.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.