A neonate presents at birth with respiratory distress and cyanosis relieved by crying. The diagnosis of bilateral choanal atresia is confirmed by failure to pass a 6 Fr catheter. Emergency management of the airway should be with:

• A Immediate neonatal tracheostomy as definitive airway management
• B Urgent nasopharyngeal intubation with bilateral catheter placement
• C Placement of an oral airway (McGovern nipple or oropharyngeal airway) to bypass nasal obstruction, followed by definitive transnasal endoscopic repair ✓
• D Bag-mask ventilation until spontaneous breathing stabilises, then observation

Explanation

Bilateral choanal atresia is a neonatal emergency because neonates are obligate nasal breathers; cyanosis is relieved by crying because this opens the mouth. Immediate airway stabilization is achieved by placing a McGovern nipple (modified nipple with enlarged hole) or an oropharyngeal airway to allow oral breathing. This temporises until definitive repair. Definitive treatment is endoscopic transnasal repair (choanoplasty) with or without stenting, performed as early as possible. Tracheostomy is reserved for cases where endoscopic repair cannot be performed or when associated anomalies preclude early repair.

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.