The Histopathological Findings of Adenoid Tissue After Topical Mometasone Furoate Implementation

Year 2018, Volume: 10 Issue: 2, 203 - 207, 15.08.2018

Fatih Alper Akcan , Hümeyra Bayram Akcan Yusuf Dundar Ahmet Uluat , Esra Karakuş

https://doi.org/10.18521/ktd.365710

Abstract

Objective: Pediatric sleep disordered breathing
(SDB) is a common childhood disease with a potential risk of several
comorbidities. The most common cause of SDB in childhood is upper
airway obstruction due to adenotonsillar hypertrophy and the classical treatment is
adenotonsillectomy. However, it carries a risk of many complications and
persistent apnea. Topical nasal steroid treatment may be an alternative to
surgery in the treatment of pediatric SDB. However, histopathological effects
of topical nasal steroids are mostly understudied.

Methods: A retrospective controlled clinical
study in an academic tertiary referral center. A total of 110 children were
involved in the study who underwent adenoidectomy for the treatment of SDB. The
study group (51-children) was treated with topical nasal mometasone furoate
monohydrate 100 mcg/day. The control group (59-children) was selected randomly
and all had no history of topical nasal steroid pre-operatively. Post-operative
adenoidectomy specimens were reviewed according to acute/chronic inflammation
findings, follicular hyperplasia, goblet cell hyperplasia, squamous metaplasia,
fibrosis, atrophy, ulcer and hemorrhage. The findings were scored
semiquantitatively for statistical analysis.

Results: Chronic inflammation findings,
follicular hyperplasia and goblet cell hyperplasia were significantly decreased
in the study group in addition fibrosis, atrophy and ulcer findings were
significantly increased in the study group. However, there was no statistical
difference between the groups according to acute inflammation and hemorrhage.

Conclusion: 
Topical nasal corticosteroids significantly suppress the nasopharyngeal
inflammatory process in SDB. This treatment may be an alternative to surgery at
least in patients with mild and moderate disease.

Keywords

Sleep disordered breathing, adenotonsillectomy, nasal corticosteroid, histopathology

Topikal Mometazon Furoat Kullanımının Adenoid Doku Üzerindeki Histopatolojik Etkisi

Abstract

Amaç: Uykuda solunum bozukluğu (USB),
birçok komorbidite riski taşıyan yaygın bir çocukluk
çağı hastalığıdır. Çocukluk çağında USB'nun en sık görülen nedeni
adenotonsiller hipertrofiye bağlı üst solunum yolu tıkanıklığıdır ve klasik
tedavi adenotonsillektomidir. Bununla birlikte, birçok komplikasyon ve persistan apne riski taşır. Pediatrik USB tedavisinde
topikal nazal steroid tedavisi cerrahiye alternatif olabilir. Bununla birlikte,
topikal nasal steroidlerin histopatolojik etkileri yeterince anlaşılamamıştır.

Gereç ve Yöntem: Çalışma üçüncü basamak bir sağlık merkezinde verilerin retrospektif olarak taranması şeklinde planlanmıştır.
Çalışmaya USB nedeni ile adenoidektomi uygulanan toplam 110 çocuk dahil edildi.
Çalışma grubuna 51 çocuk, topikal mometazon furoat monohidrat 100 mcg/gün ile
tedavi edilmişti. Kontrol grubu (59 çocuk) rasgele
seçildi ve preoperatif olarak topikal nasal steroid öyküsü yoktu. Ameliyat
sonrası adenoidektomi örnekleri, akut/kronik inflamasyon bulguları, foliküler
hiperplazi, goblet hücre hiperplazisi, skuamoz metaplazi, fibrozis, atrofi, ülser ve kanamaya göre gözden geçirildi.
Bulgular istatistiksel analiz için semikantitatif olarak değerlendirildi.

Bulgular: Çalışma grubunda kronik
inflamasyon bulguları, foliküler hiperplazi ve goblet hücre hiperplazisi anlamlı olarak azalırken, fibrozis, atrofi ve ülser
bulguları anlamlı olarak arttı. Bununla birlikte akut enflamasyon ve kanama
açısından gruplar arasında istatistiksel olarak bir fark yoktu.

Sonuç: Topikal nazal kortikosteroidler
USB'de nazofaringeal inflamatuvar süreci önemli
derecede bastırmaktadır. Bu tedavi, en azından hafif ve orta şiddette USB olan
hastalarda cerrahiye alternatif olabilir.

Keywords

Uykuda Solunum Bozukluğu, Adenotonsillektomi, Nazal Kortikosteroid, Histopatolojİ

References

• 1. Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 2008;5(2):242-52.
• 2. Schlaud M, Urschitz MS, Urschitz-Duprat PM et al. The German study on sleep-disordered breathing in primary school children: epidemiological approach, representativeness of study sample, and preliminary screening results. Pediatr PerinatEpidemiol 2004;18(6):431–440.
• 3. Kaditis AG, Finder J, Alexopoulos EI et al. Sleep-disordered breathing in 3,680 Greek children. Pediatr Pulmonol 2004; 37(6):499–509.
• 4. Chervin RD, Archbold KH, Dillon JE et al. Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics 2002;109(3):449-56.
• 5. Urschitz MS, Guenther A, Eggebrecht E et al. Snoring, intermittent hypoxia and academic performance in primary school children. Am J Respir Crit Care Med 2003;168(4):464-8.
• 6. Urschitz MS, Eitner S, Guenther A et al. Habitual snoring, intermittent hypoxia, and impaired behavior in primary school children. Pediatrics 2004;114(4):1041-8.
• 7. Schechter MS; American Academy of Pediatrics, Section on Pediatrics Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109(4):e69.
• 8. Alexopoulos EI, Kaditis AG, Kalampouka E et al. Nasal corticosteroids for children with snoring. Pediatr Pulmonol 2004;38(2):161-7.
• 9. Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 2006;117(1):e61-6.
• 10. Kuhle S, Urschitz MS. Anti-inflammatory medications for obstructive sleep apnea in children (Review) Cochrane Database Syst Rev 2011;(1):CD007074.
• 11. Bousquet J, Reid J, van-Weel C et al. Allergic rhinitis management pocket reference 2008. Allergy 2008;63(8):990-6.
• 12. Capdevila OS, Kheirandish-Gozal L, Dayyat E et al. Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc AmThorac Soc 2008;5(2):274-82.
• 13. Arnaud C, Dematteis M, Pepin JL et al. Obstructive sleep apnea, immuno-inflammation, and atherosclerosis. Semin Immunopathol 2009;31(1):113-25.
• 14. Unnikrishnan D, Jun J, Polotsky V. Inflammation in sleep apnea: An update. Rev Endocr Metab Disord 2015;16(1):25-34.
• 15. Bhattacharjee R, Kheirandish-Gozal L, Spruyt K et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 2010;182(5):676-83.
• 16. Costa DJ, Mitchell R. Adenotonsillectomy for obstructive sleep apnea in obese children: a meta-analysis. Otolaryngol Head Neck Surg 2009;140(4):455-60.
• 17. Konstantinopoulou S, Gallagher P, Elden L et al. Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children. Int J Pediatr Otorhinolaryngol 2015;79(2):240-5.
• 18. Gozal D. Sleep, sleep disorders and inflammation in children. Sleep Med 2009;10 Suppl 1:S12-6.
• 19. Scadding G. Non-surgical treatment of adenoidal hypertrophy: the role of treating IgE-mediated inflammation. Pediatr Allergy Immunol 2010;21(8):1095-106.
• 20. Al-Ghamdi SA, Manoukian JJ, Morielli A et al. Do systemic corticosteroids effectively treat obstructive sleep apnea secondary to adenotonsillar hypertrophy? Laryngoscope 1997;107(10):1382-1387.
• 21. Berlucchi M, Valetti L, Parrinello G et al. Long-term follow-up of children undergoing topical intranasal steroid therapy for adenoidal hypertrophy. Int J Pediatr Otorhinolaryngol 2008;72: 1171-1175.
• 22. Demain JG, Goetz DW. Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone. Pediatrics 1995;95(3):355-364.
• 23. Cengel S, Akyol MU. The role of topical nasal steroids in the treatment of children with otitis media with effusion and/or adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 2006;70(4): 639-645.
• 24. Rezende RM, Silveira F, Barbosa AP et al. Objective reduction in adenoid tissue after mometasone furoate treatment. Int J Pediatr Otorhinolaryngol 2012;76(6):829-31.
• 25. Andersson M, Andersson P, Pipkorn U. Topical glucocorticosteroids and allergen-induced increase in nasal reactivity: relationship between treatment time and inhibitory effect. J Allergy Clin Immunol 1988;82(6):1019-26.
• 26. Holm AF, Godthelp T, Fokkens WJ et al. Long-term effects of corticosteroid nasal spray on nasal inflammatory cells in patients with perennial allergic rhinitis. Clin Exp Allergy 1999;29(10):1356-66.
• 27. Kheirandish-Gozal L, Serpero LD, Dayyat E et al. . Corticosteroids suppress in vitro tonsillar proliferation in children with obstructive sleep apnoea. Eur Respir J 2009;33(5):1077-84.
• 28. Goldbart AD, Veling MC, Goldman JL et al. Glucocorticoid receptor subunit expression in adenotonsillar tissue of children with obstructive sleep apnea. Pediatr Res 2005;57(2):232-6.
• 29. Hollenberg SM, Weinberger C, Ong ES et al. Primary structure and expression of a functional human glucocorticoid receptor cDNA. Nature 1986;318(6047):635-41.
• 30. Christodoulopoulos P, Leung DY, Elliott MW et al. Increased number of glucocorticoid receptor-beta-expressing cells in the airways in fatal asthma. J Allergy Clin Immunol 2000;106(3):479-484.
• 31. Webster JC, Oakley RH, Jewell CM et al. Proinflammatory cytokines regulate human glucocorticoid receptor gene expression andlead to the accumulation of the dominant negative beta isoform: a mechanism for thegeneration of glucocorticoid resistance. Proc Natl Acad Sci USA 2001;98(12):6865-70.
• 32. Hamilos DL, Leung DY, Muro S et al. Beta expression in nasal polyp inflammatory cells and its relationship to the anti-inflammatory effects of intranasal fluticasone. J Allergy Clin Immunol 2001;108(1):59-68.
• 33. Kadhim AL, Spilsbury K, Semmens JB et al. Adenoidectomy for middle ear effusion: a study of 50,000 children over 24 years. Laryngoscope 2007;117(3):427-33.
• 34. Yasan H, Dogru H, Tüz M et al. Otitis media with effusion and histopathologic properties of adenoid tissue. Int J Pediatr Otorhinolaryngol 2003;67(11):1179-83.
• 35. Eftekharian A, Sabeti S, Khajavi M et al. Light microscopic histopathology of adenoid tissue in otitis media with effusion: is there any relation? Int J Pediatr Otorhinolaryngol 2012;76(11):1598-600.