Are nasal steroids effective in children with adenoid hypertrophy?

Year 2019, Volume: 5 Issue: 2, 311 - 318, 04.03.2019

Fevzi Solmaz , Mustafa Erhan Aşçıoğlu Osman Durgut , Oğuzhan Dikici , Mehmet Haksever , Davut Akduman

https://doi.org/10.18621/eurj.405439

Cited By: 6

Abstract

Objectives: Chronic
nasal obstruction is a common disease of childhood. Adenotonsillar hypertrophy
plays an important role in obstructive sleep apnea. The topical use of the
aerosolized forms of corticosteroids therefore seems the most appropriate route
to decrease systemic side effects. The aim of our study is to demonstrate the
effect of topical mometasone furoate especially on the adenoid volume in
patients without any allergic story.

Methods: The study
group consisting of 30 males and 25 females was administered topical nasal
mometasone furoate steroid treatment. The 20 patients were in the control group
where saline solution (0.9% NaCl) treatment was administered consisted of 12
males and 8 females. Nasopharyngeal X-rays before treatment revealed that 25
patients were Grade 2 and 30 patients were Grade 3 according to the Fujioka method.

Results: Flexible
endoscopy performed before the treatment revealed that 20 patients were Grade 2,
11 patients were Grade 3 and 24 patients were Grade 4. Nasal endoscopies
performed after 6 weeks of intranasal topical steroid therapy revealed that 45
patients were Grade 1 and 10 patients were Grade 2. A statistically significant
difference was present between endoscopic grades before and after treatment (p
< 0.0001). Nasal endoscopies performed after 6 weeks in control group
receiving saline solution treatment revealed Grade 2 in 7 patients, Grade 3 in
10 patients and Grade 4 in 3 patients. There was no statistically significant
difference between in the prior and later grades of the control group (p =
0.3125).

Conclusions:
We believe that the
use of intranasal steroids (mometasone furoate) for 6 weeks in patients with
pediatric chronic nasal obstruction due to adenoid hypertrophy may be an
effective treatment modality in alleviating symptoms and decreasing adenoid
volume without causing systemic side effects. 

Keywords

Nasal steroids, adenoid hypertrophy, flexible endoscopy, nasopharyngeal X-rays, Fujioka method

References

• [1] Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 2008;5:242-52.
• [2] O’Brien LM, Holbrook CR, Mervis CB. Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Pediatrics 2003;111:554-63.
• [3] Blunden S, Lushington K, Lorenzen B, Wong J, Balendran R, Kennedy D. Symptoms of sleep breathing disorders in children are underreported by parents at general practice visits. Sleep Breath 2003;7:167-76.
• [4] Kheirandish-Gozal L, Gozal D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics 2008;122;e149-55.
• [5] Marcus CL. Sleep-disordered breathing in children. Am J Respir Crit Care Med 2001;164:16-30.
• [6] Raphael G, Kaliner M. The tonsils and adenoids: Allergy and the pharyngeal lymphoid tissue. In Otolaryngologic Clinics of North America. Edited by Kornblut AD, Saunders WB: Philadelphia, 1987:pp. 295-303.
• [7] Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D. Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 2008;5:274-82.
• [8] Cowan DL, Hibbert J. Tonsils and adenoids: In Scott Browns Pediatric Otolaryngology (Vol. 6) 6th edition. Edited by Kerr AG, Adams DA, Cinnamond MJ. Butterworth Heinemann, Oxford Chpt 1997;18, p.4-8.
• [9] Li AM, Wong E, Kew J, Hui S, Fok TF. Use of tonsil size in the evaluation of obstructive sleep apnoea. Arch Dis Child 2002;87:156-9.
• [10] Schechter MS. Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Pediatrics 2002;109: e69.
• [11] American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:704-12.
• [12] Brodsky L. Modern assessment of tonsil and adenoids. Pediatr Clin North Am 1989;36:1551-69.
• [13] Tracy JM, Demain JG, Hoffman KM, Goetz DW. Intranasal beclomethasone as an adjuvant to treatment of chronic middle ear effusion. Ann Allergy Asthma Immunol 1998;80:198-206.
• [14] Brannan MD, Herron JM, Affrime MB. Safety and tolerability of once-daily mometasone furoate aqueous nasal spray in children. Clin Ther 1997;19:1330-9.
• [15] Kheirandish-Gozal L, Serpero LD, Dayyat E, Kim J, Goldman JL, Snow A. Corticosteroids suppress in vitro tonsillar proliferation in children with obstructive sleep apnoea. Eur Respir J 2009;33:1077-84.
• [16] Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep disordered breathing in children. Am J Respir Crit Care Med 2005;172:364-70.
• [17] Brouillette RT, Manoukian JJ, Ducharme FM, Oudjhane K, Earle LG, Ladan S. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 2001;138:838-44.
• [18] Alexopoulos EI, Kaditis AG, Kalampouka E, Kostadima E, Angelopoulos NV, Mikraki V. Nasal corticosteroids for children with snoring. Pediatr Pulmonol 2004;38:161-7.
• [19] Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. Am J Roentgenol 1979;133:401-4.
• [20] Demain JG, Goetz DW. Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone. Pediatrics 1995;95:355-64.
• [21] Lepcha A, Kurien M, Job A, Jeyaseelan L, Kurien T. Chronic adenoid hypertrophy in children - is steroid nasal spray beneficial? Indian J Otolaryngol Head Neck Surg 2002;54:280-4.
• [22] Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing following tonsillectomy and adenoidectomy in children. Pediatrics 2006;117:e61-6.
• [23] Jung YG, Kim HY, Min JY, Hun JD, Seung KC. Role of intranasal topical steroid in pediatric sleep disordered breathing and influence of allergy, sinusitis, and obesity on treatment outcome. Clin and Exp Otorhinolaryngol 2011;4:27-32.
• [24] Minshall E, Ghaffar O, Cameron L, O’Brien F, Quinn H, Rowe-Jones J. Assessment by nasal biopsy of long-term use of mometasone furoate aqueous nasal spray (Nasonex) in the treatment of perennial rhinitis. Otolaryngol Head Neck Surg 1998;118:648-54.
• [25] Boner AL. Effects of intranasal corticosteroids on the hypothalamic-pituitary-adrenal axis in children. J Allergy Clin Immunol 2001;108:32-9.
• [26] Berlucchi M, Salsi D, Valetti L, Parrinello G, Nicolai P. The role of mometasone furoate aqueous nasal spray in the treatment of adenoidal hypertrophy in the pediatric age group: preliminary results of a prospective, randomized study. Pediatrics 2007;119:e1392-7.
• [27] Cengel S, Akyol MU. The role of topical nasal steroids in the treament of children with otitis media with effusion and/or adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 2006;70:639-45.
• [28] Kimoff RJ, Hamid Q, Divangahi M, Hussain S, Bao W, Naor N. Increased upper airway cytokines and oxidative stress in severe obstructive sleep apnoea. Eur Respir J 2011;38:89-97.
• [29] Mlynarek A, Tewfik MA, Hagr A, Manoukian JJ, Schloss MD, Tewfik TL. Lateral neck radiography versus direct video rhinoscopy in assessing adenoid size. J Otolaryngol 2004;33:360-5.