Association between congenital nasolacrimal duct obstruction and upper airway pathology: insights from a large multicenter cohort.

PURPOSE: To evaluate the association between CNLDO and adenoid hypertrophy, adenoidectomy, obstructive sleep apnea (OSA), and tonsillar hypertrophy, using data from a large multicenter electronic health record network.

METHODS

This retrospective, multicenter cohort study used data from TriNetX, a large global electronic health record network. A total of 16,007 children with CNLDO were included and compared with an equal number of propensity score-matched controls without CNLDO. Strict exclusion criteria were applied to omit patients with congenital malformations, deformations, chromosomal abnormalities, complications of labor, maternal or perinatal complications, or ocular trauma. The primary outcomes were the 5-year incidence rates of adenoid hypertrophy, adenoidectomy, OSA, and tonsillar hypertrophy.

RESULTS

Children with CNLDO had significantly higher rates of adenoid hypertrophy (1.45% vs 1.15%; HR = 1.28; 95% CI, 1.05-1.55; P = 0.013), adenoidectomy (0.96% vs 0.62%; HR = 1.57; 95% CI, 1.22-2.02; P = 0.0004), and OSA (1.40% vs 1.11%; HR = 1.27; 95% CI, 1.04-1.55; P = 0.017) compared with matched controls. Tonsillar hypertrophy showed a positive trend (2.78% vs 2.46%; HR = 1.14; 95% CI, 1.00-1.31; P = 0.051).

CONCLUSIONS

A significant association was found between CNLDO and adenoid hypertrophy, adenoidectomy, and obstructive sleep apnea. This association may imply that upper airway pathology contributes directly to the development of CNLDO, or that both conditions share common predispositions and arise independently.