A term neonate has biphasic stridor, recurrent desaturation and endoscopy showing both vocal folds near the midline. The airway worsens despite non-invasive support. What is the best next step?
Severe bilateral immobility can rapidly threaten ventilation. Airway stabilisation, usually with a reversible strategy, precedes definitive lateralising surgery while prognosis and cause are established.
A. Observe at home because the cry is strong: Voice may be relatively preserved despite a critically narrow glottis.
B. Immediate bilateral cordectomy: Irreversible tissue removal is inappropriate before aetiology and recovery potential are known.
C. Secure a reliable airway while investigating neurological, central and iatrogenic causes: Severe bilateral immobility can rapidly threaten ventilation. Airway stabilisation, usually with a reversible strategy, precedes definitive lateralising surgery while prognosis and cause are established.
D. Treat empirically as laryngomalacia: The endoscopic finding identifies a different level and mechanism of obstruction.
E. Start oral feeding challenges during desaturation: Feeding may worsen aspiration and does not secure ventilation.
If the airway were stable with adequate growth and no hypoxic episodes, monitored observation while investigating recovery could avoid tracheostomy.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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