A neonate presents with respiratory distress at rest that improves with crying. Oro-pharyngeal airway examination shows a normal pharynx. The most likely diagnosis is:
- A Adenoid hypertrophy causing nasopharyngeal obstruction
- B Bilateral choanal atresia ✓
- C Laryngomalacia causing inspiratory stridor
- D Congenital nasal pyriform aperture stenosis
Correct answer: B. Bilateral choanal atresia
Explanation
Neonates are obligate nasal breathers. Bilateral choanal atresia presents as cyclic respiratory distress at rest that immediately improves with crying (because oral breathing occurs during crying). The diagnosis is confirmed by inability to pass a 5F catheter more than 3 cm through either nostril and CT nose/PNS showing bony/membranous obstruction. It requires urgent nasal airway establishment (Guedel airway, McGovern nipple) followed by definitive trans-nasal endoscopic repair. Laryngomalacia causes inspiratory stridor that worsens with crying.
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.