Examination of lateral nasal wall pathologies associated with distal lacrimal duct obstruction

Amaç: Bu çal›flmada lateral nazal duvar ve sinüs patolojilerinin distallakrimal kanal t›kan›kl›¤› etiyolojisindeki rolü araflt›r›lm›flt›r.Yöntem: Nisan 1999 ile Eylül 2003 tarihleri aras›nda endoskopikendonazal dakriosistorinostomi ve silikon entübasyonu planlanan 17kad›n ve 11 erkek hasta çal›flmaya dahil edildi. Hastalar›n lakrimal kanal t›kan›kl›¤› tan›s› için göz kliniklerinde Schirmer testi, flöreseinboya kaybolma testi, Jones I-II testleri, kanaliküler irrigasyon, kanaliküler problama, dakriosistografi, dakriosintigrafi gibi genel oftalmolojik muayeneleri yap›ld›. KBB kliniklerinde nazal kavite patolojileri için anterior rinoskopi ve diagnostik nazal endoskopik muayeneleri yap›ld›. Tüm hastalarda paranazal bilgisayarl› tomografi ile ostiomeatal kompleks hastal›¤›, etmoid hücre opasifikasyonu, konka bülloza, agger nazi hücresi varl›¤› de¤erlendirilerek 50 kontrol olgusundaki bulgular ile Fisher’in ki-kare testiyle karfl›laflt›r›ld›.Bulgular: Lakrimal kanal t›kan›kl›¤›n oldu¤u tarafta agger nazi hücresi 17 (%60.7), konka bülloza 10 (%35.7), etmoid hücre opasifikasyonu 6 (%21.4), osteomeatal kompleks hastal›¤› 4 (%14.2), bir veyadaha fazla bulgu 21 (%75) hastada saptand›. Bu lateral nazal duvar vesinüs patolojileri çal›flma grubunda kontrol grubuna oranla yüksekbulunmas›na karfl›l›k istatistiksel olarak anlaml› bulunmad›(p>0.05).Sonuç: Lateral nazal duvar ve sinüs patolojilerini distal nazolakrimalsistem t›kan›kl›¤› olan hastalarda yüksek oranda bulmam›za ra¤menetiyolojisini aç›klamakta yetersiz oldu¤u ve paranazal bilgisayarl› tomografinin bu hastalar›n de¤erlendirilmesinde artan öneme sahipolaca¤› kan›s›na vard›k.
Objective: In this study, the role of lateral nasal wall and sinus pathologies in the etiology of distal lacrimal duct disease has been investigated.Methods: Seventeen female and 11 male patients who were scheduledfor endoscopic endonasal dacryocystorhinostomy and silicon tube intubation between April 1999 and September 2003 were included in the study.The patients underwent general ophthalmologic examinations such asSchirmer test, fluorescein dye disappearance test, Jones I-II tests, canalicular irrigation, canalicular probing, dacryocystography, dacryoscintigraphy for the diagnosis of lacrimal duct obstruction. In the clinics of ENT,for the detection of nasal cavity pathologies, anterior rhinoscopy anddiagnostic nasal endoscopic examinations were performed. All patientswere evaluated during paranasal computed tomographic examinationsregarding osteomeatal complex disease, ethmoid cell opacification, concha bullosa and presence of agger nasi cells and data obtained were compared with findings of 50 control subjects using Fisher’s chi-square tests.Results: On the side where lacrimal duct obstruction exists, agger nasicells were detected in 17 (60.7%) patients, concha bullosa in 10 (35.7%)patients, ethmoid cell opacification in 6 (21.4%) patients, osteomeatalcomplex disease in 4 (14.2%) patients, and one or more than one symptom were detected in 21 (75%) patients. Despite higher number of lateral nasal wall and sinus pathologies in the study group when comparedwith the control group, intergroup difference was not statistically significant (p>0.05).Conclusion: We have concluded that despite the higher rates of lateral nasal wall and sinus pathologies in patients with distal nasolacrimalsystem obstruction, its etiology has not been adequately expounded andparanasal computed tomographies will have increasing importance inthe evaluation of these patients.