FRCS (ORL-HNS) · SECTION 1 SBA

Bilateral choanal atresia

A term neonate becomes cyanotic while feeding and settles when crying. Passing a nasal catheter fails bilaterally. What is the best immediate action?

CHOOSE ONE ANSWER

Best of five

  1. A. Wait for CT before relieving obstruction
  2. B. Attempt repeated blind nasal probing
  3. C. Discharge with feeding advice
  4. D. Establish an oral airway and obtain urgent neonatal ENT assessment
  5. E. Treat as uncomplicated reflux
ANSWER AND REASONING

D. Establish an oral airway and obtain urgent neonatal ENT assessment

Neonates are preferential nasal breathers. Initial management is airway stabilisation; definitive confirmation and surgical planning follow once oxygenation is protected.

Why every option is right or wrong

A. Wait for CT before relieving obstruction: Imaging must not delay airway support.

B. Attempt repeated blind nasal probing: This can cause trauma and does not provide controlled airway management.

C. Discharge with feeding advice: The presentation risks recurrent hypoxia.

D. Establish an oral airway and obtain urgent neonatal ENT assessment: Neonates are preferential nasal breathers. Initial management is airway stabilisation; definitive confirmation and surgical planning follow once oxygenation is protected.

E. Treat as uncomplicated reflux: The cry–feed pattern and bilateral catheter failure point to nasal obstruction.

What if the scenario changed?

If the obstruction were unilateral and the infant stable, assessment could be less emergent but still needs specialist confirmation.