FRCS (ORL-HNS) · SECTION 1 SBA

Unilateral choanal atresia

A child has persistent unilateral nasal discharge and obstruction since infancy. Endoscopy suggests unilateral choanal atresia. What is the most useful confirmatory investigation for operative planning?

CHOOSE ONE ANSWER

Best of five

  1. A. Plain chest radiograph
  2. B. Dix–Hallpike testing
  3. C. Thin-section CT of the nose and skull base after clearing secretions
  4. D. Barium swallow
  5. E. Routine brain EEG
ANSWER AND REASONING

C. Thin-section CT of the nose and skull base after clearing secretions

CT defines the bony and membranous components and skull-base anatomy. Unilateral disease is rarely a neonatal emergency but should be distinguished from foreign body and mass.

Why every option is right or wrong

A. Plain chest radiograph: This does not assess the posterior nasal aperture.

B. Dix–Hallpike testing: This assesses positional vertigo.

C. Thin-section CT of the nose and skull base after clearing secretions: CT defines the bony and membranous components and skull-base anatomy. Unilateral disease is rarely a neonatal emergency but should be distinguished from foreign body and mass.

D. Barium swallow: The lesion is nasal, not oesophageal.

E. Routine brain EEG: There is no seizure presentation.

What if the scenario changed?

If obstruction were bilateral in a cyanotic neonate improving when crying, immediate airway support would take priority over elective imaging.

EDUCATIONAL USE

Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.

Back to the Section 1 bank