A neonate presents with respiratory distress at birth that worsens with feeding but improves with crying. Inability to pass a suction catheter through the nasal passages is noted. The most likely diagnosis is:

• A Congenital nasal dermoid
• B Nasal glioma
• C Piriform aperture stenosis
• D Choanal atresia ✓

Explanation

Bilateral choanal atresia presents at birth with cyclical cyanosis: neonates are obligate nasal breathers, so bilateral obstruction causes cyanosis at rest that improves with crying (mouth breathing). Feeding worsens cyanosis as the mouth is used for suckling rather than breathing. Failure to pass a suction catheter 5-7 cm through the nose confirms the diagnosis. Unilateral atresia may not present until childhood with persistent unilateral nasal discharge. CT scan of the choanae confirms bony or membranous atresia and guides surgical planning.

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.