A neonate presents at birth with respiratory distress that worsens during feeding and improves with crying. Oral airway insertion relieves the distress. The most likely diagnosis is:

• A Pierre Robin sequence
• B Bilateral vocal cord palsy
• C Congenital subglottic stenosis
• D Bilateral choanal atresia ✓

Explanation

Bilateral choanal atresia classically presents as cyclic cyanosis in the neonate — cyanosis during feeding (when nasal breathing is required) and relief during crying (obligate mouth breathing). Because neonates are obligate nasal breathers, bilateral obstruction causes severe respiratory distress. An oral airway or McGovern nipple relieves symptoms immediately. CT confirms bony or membranous posterior choanal obstruction. Surgical correction (transnasal endoscopic puncture and dilation) is definitive.

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.