Association between congenital nasolacrimal duct obstruction and otitis media

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.