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  • Treating Otitis Media in Children with CNLDO Could Require T-tube Placement

    Oculoplastics/Orbit, Pediatric Ophth/Strabismus

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    Review of: High incidence and recurrence of tympanostomy tube procedures in children who underwent nasolacrimal duct probe and intubation for congenital nasolacrimal duct obstruction

    Vicinanzo M, Cooper K, Gerber A, et al. Journal of American Association for Pediatric Ophthalmology and Strabismus, October 2023

    Children with congenital nasolacrimal duct obstruction (CNLDO) who need probing and intubation (P&I) for otitis media (OM) are at higher risk of multiple tympanostomy tube (T-tube) placements in the ear later on.

    Study Design

    This study was a prospective case series involving 92 consecutive children aged 10–24 months diagnosed with CNLDO who were treated with P&I of the lacrimal system at a single institution between January 2006 and December 2014. A preoperative questionnaire was sent to parents and caregivers regarding CNLDO laterality, history of antibiotic-requiring OM, and history of T-tube placement in the ear for OM, including the number of T-tubes placed. A follow-up questionnaire regarding symptom resolution was sent 12 months after the P&I procedure.

    Outcomes

    Forty percent of children with CNLDO required ear T-tube placement, nearly 6 times the incidence rate (7%) reported in the general population. Fifty-six percent of those who had T-tube placement required ≥2 sets. Persistent epiphora following P&I was seen in 16% of children who had T-tube placement, compared with 2% of children with no history of T-tube placement.

    Limitations

    The limitations of this study include the small sample size and the potential selection bias of children treated at an academic center, who may present with more severe disease.

    Clinical Significance

    Associations between CNLDO and OM have been noted in previous studies. This study demonstrated that children with CLNDO seen in an academic setting seem to have more severe disease, with recurrent T-tube placement and persistent epiphora after treatment. The treating physician should take this possible association into consideration. A collaborative surgical approach could be considered for same-day P&I and T-tube placement to save the child from multiple rounds of anesthesia. In addition, in those children with concurrent disease, parents and caregivers should be counseled for the possible need of additional surgery.

    Financial Disclosures: Dr. Richard Allen discloses no financial relationships.