The Histopathological Findings of Adenoid Tissue After Topical Mometasone Furoate Implementation

Yıl 2018, Cilt: 10 Sayı: 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

Öz

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.

Anahtar Kelimeler

Sleep disordered breathing, adenotonsillectomy, nasal corticosteroid, histopathology

Topikal Mometazon Furoat Kullanımının Adenoid Doku Üzerindeki Histopatolojik Etkisi

Öz

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.

Anahtar Kelimeler

Uykuda Solunum Bozukluğu, Adenotonsillektomi, Nazal Kortikosteroid, Histopatolojİ

Kaynakça

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