Linaburg Taylor J, Binenbaum Gil, Buzi Adva, Spiller Alyssa, Yu Yinxi, Ying Gui-Shuang, Katowitz William R
Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
J AAPOS. 2025 Jun;29(3):104211. doi: 10.1016/j.jaapos.2025.104211. Epub 2025 May 9.
Anatomic abnormalities causing congenital nasolacrimal duct obstruction (cNLDO) may be coincident with abnormalities predisposing to otitis media (OM). We evaluated the association between cNLDO and OM, considering surgical intervention as a marker of more severe disease.
We performed a retrospective cross-sectional study of children <5 years of age who received care from both a pediatrician and ophthalmologist at Children's Hospital of Philadelphia. Primary outcomes were associations between diagnoses of cNLDO by ophthalmologists and OM by pediatricians or otolaryngologists, and between cNLDO requiring surgical intervention and OM requiring surgical intervention. Subgroup analysis among children with OM was performed to assess for associations between cNLDO without surgery or cNLDO surgery and the need for myringotomy tubes (MT).
Of 43,793 children studied, 1,571 (3.6%) had cNLDO, and 1,262 (2.9%) underwent cNLDO surgery. 16,947 (38.7%) had OM, and 4,433 (10.1%) underwent OM surgery with MT placement. cNLDO was significantly associated with OM (OR = 2.9; 95% CI, 2.6-3.2 [P < 0.001]). cNLDO surgery was significantly associated with MT placement (OR = 2.8; 95% CI, 2.4-3.2 [P < 0.001]). In children with OM, cNLDO requiring surgery was significantly associated with need for MT (OR = 2.0; 95% CI, 1.7-2.4 [P < 0.001]), but cNLDO not requiring surgery was not (OR = 0.9; 95% CI, 0.7-1.1).
We found associations between cNLDO and OM, and between cNLDO surgery and MT placement both overall and specifically among children with OM, suggesting coincident anatomic abnormalities predisposing to both conditions. Pediatricians, pediatric otolaryngologists and ophthalmologists should be aware that for children with OM, history of cNLDO surgery may be a predictor of eventual need for MT.
导致先天性鼻泪管阻塞（cNLDO）的解剖异常可能与易患中耳炎（OM）的异常同时存在。我们评估了cNLDO与OM之间的关联，将手术干预视为更严重疾病的一个标志。
我们对费城儿童医院同时接受儿科医生和眼科医生诊治的5岁以下儿童进行了一项回顾性横断面研究。主要结局是眼科医生诊断的cNLDO与儿科医生或耳鼻喉科医生诊断的OM之间的关联，以及需要手术干预的cNLDO与需要手术干预的OM之间的关联。对患有OM的儿童进行亚组分析，以评估未进行手术的cNLDO或cNLDO手术与鼓膜切开置管（MT）需求之间的关联。
在研究的43793名儿童中，1571名（3.6%）患有cNLDO，1262名（2.9%）接受了cNLDO手术。16947名（38.7%）患有OM，4433名（10.1%）接受了OM手术并放置了MT。cNLDO与OM显著相关（OR = 2.9；95% CI，2.6 - 3.2 [P < 0.001]）。cNLDO手术与MT放置显著相关（OR = 2.8；95% CI，2.4 - 3.2 [P < 0.001]）。在患有OM的儿童中，需要手术的cNLDO与MT需求显著相关（OR = 2.0；95% CI，1.7 - 2.4 [P < 0.001]），但不需要手术的cNLDO则不然（OR = 0.9；95% CI，0.7 - 1.1）。
我们发现cNLDO与OM之间以及cNLDO手术与MT放置之间存在关联，无论是总体上还是在患有OM的儿童中尤其如此，这表明存在易导致这两种疾病的共同解剖异常。儿科医生、儿科耳鼻喉科医生和眼科医生应意识到，对于患有OM的儿童，cNLDO手术史可能是最终需要MT的一个预测因素。
