Samarei Reza, Samarei Vafa, Aidenloo Naser Samadi, Fateh Nasrin
Department of Otolaryngology, Urmia University of Medical Sciences, Urmia, Iran.
Department of Ophthalmology, Urmia University of Medical Sciences, Urmia, Iran.
Eurasian J Med. 2020 Feb;52(1):21-24. doi: 10.5152/eurasianjmed.2019.19034.
Primary acquired nasolacrimal duct obstruction (PANDO) is an idiopathic narrowing of the nasolacrimal duct caused by chronic inflammation and consecutive stenosis of the nasal tissue. In the current investigation, we aimed to study the etiopathogenic role of sinonasal anatomical abnormalities and paranasal inflammatory pathologies in PANDO.
Computed tomography (CT) findings of 459 patients who were diagnosed with unilateral PANDO between April 2009 and March 2017 were compared with that of a control group, which comprised 200 subjects without nasolacrimal duct obstruction who had been referred to the ear nose throat (ENT) clinic with the complaint of vertigo and headache. A radiologist (R. S.) masked to the clinical situation of participants retrospectively examined their CT findings.
The prevalence of deviated nasal septum was found to be strongly associated with PANDO incidence (55.3% on PANDO side of patients vs. 28.3% among controls; p<0.001). Significant increases, albeit of smaller magnitude, were also observed in the relative frequency of Agger nasi cells and maxillary sinusitis on the PANDO side of the subjects (14.6% and 27.0%, respectively) compared to controls (9.5% and 20.6%, respectively) (p=0.023 and p=0.038, respectively). Unilateral PANDO was also found to be robustly associated with an ipsilateral deviated nasal septum (p<0.001). The odds of septal deviation occurrence were 3.037 times (95% Confidence Interval (CI): 2.303-3.990; p<0.001) more on the PANDO than the non-PANDO side of the studied cases.
Ipsilaterally deviated nasal septum appears to have a role in the development of unilateral primary acquired obstructive disease of the lacrimal drainage system. The incidence of PANDO might also be affected by Agger nasi cells and maxillary sinusitis. Multicenter studies are essential to further elucidate the interaction between type, severity, extent, and dimensions of different pathologies with nasolacrimal duct obstruction.
原发性获得性鼻泪管阻塞（PANDO）是一种由慢性炎症和鼻组织连续性狭窄引起的鼻泪管特发性狭窄。在本研究中，我们旨在探讨鼻窦解剖异常和鼻旁炎性病变在PANDO发病机制中的作用。
将2009年4月至2017年3月期间诊断为单侧PANDO的459例患者的计算机断层扫描（CT）结果与一个对照组进行比较，该对照组由200名无鼻泪管阻塞的受试者组成，这些受试者因眩晕和头痛主诉被转诊至耳鼻喉（ENT）门诊。一名对参与者临床情况不知情的放射科医生（R.S.）对他们的CT结果进行回顾性检查。
发现鼻中隔偏曲的患病率与PANDO发病率密切相关（患者PANDO侧为55.3%，而对照组为28.3%；p<0.001）。与对照组（分别为9.5%和20.6%）相比，受试者PANDO侧鼻丘气房和上颌窦炎的相对频率也有显著增加，尽管增幅较小（分别为14.6%和27.0%）（分别为p=0.023和p=0.038）。还发现单侧PANDO与同侧鼻中隔偏曲密切相关（p<0.001）。在所研究病例中，鼻中隔偏曲发生的几率在PANDO侧比非PANDO侧高3.037倍（95%置信区间（CI）：2.303 - 3.990；p<0.001）。
同侧鼻中隔偏曲似乎在单侧原发性获得性泪道阻塞性疾病的发生中起作用。PANDO的发病率也可能受鼻丘气房和上颌窦炎影响。多中心研究对于进一步阐明不同病理类型、严重程度、范围和大小与鼻泪管阻塞之间的相互作用至关重要。
