A neonate is diagnosed with bilateral choanal atresia presenting with cyclical cyanosis (cyanotic at rest, relieved by crying). The bony form accounts for what percentage, and what is the definitive treatment?
- A 10% bony; definitive = observation and feeding therapy
- B 50% bony; definitive = external rhinoplasty approach
- C 90% bony (or mixed bony-membranous) and 10% purely membranous; definitive = transnasal endoscopic choanal atresia repair after airway stabilization (oral airway/McGovern nipple) ✓
- D 100% membranous; definitive = bedside needle puncture
Correct answer: C. 90% bony (or mixed bony-membranous) and 10% purely membranous; definitive = transnasal endoscopic choanal atresia repair after airway stabilization (oral airway/McGovern nipple)
Explanation
Choanal atresia is 90% bony or mixed bony-membranous and only 10% purely membranous (updated from the older teaching of 70/30). Bilateral atresia is a neonatal emergency because neonates are obligate nasal breathers — cyclical cyanosis at rest relieved by crying (mouth breathing) is classic. Immediate management: McGovern nipple (modified oral airway) + nasal intubation if needed. Definitive repair is transnasal endoscopic perforation and stenting after the infant is stabilized. Associated with CHARGE syndrome (50% of bilateral cases).
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.