Role of mometasone furoate nasal spray in children with adenoid hypertrophy: impact on life style changes
Keywords:Adenoid hypertrophy, Mometasone furoate, Nasal obstruction index, Adenoidectomy, Obstructive sleep apnea syndrome
Background: Adenoid hypertrophy (AH) is a common cause of upper airway obstruction and obstructive sleep apnea syndrome (OSAS) in children having major impact on child’s growth and development. Symptoms like nasal congestion, mouth breathing, nasal discharge, snoring, day time sleepiness, hyponasal voice, ear popping, and craniofacial abnormalities are observed. Adenoidectomy is considered the treatment of choice for symptomatic children. Co-existing medical illnesses and choice of surgical treatment is governed by the paediatricians and apprehensive parents. Need for conservative treatments in alleviating symptoms have been tried. Topical, intranasal administered, steroid preparations have been proven effective in the literature.
Methods: In this prospective study, 35 symptomatic children (3-12 years) with adenoid hypertrophy were included. Each of the symptoms was scored from 0 (absent) to 4 (severe) over Visual Analogue Scale (VAS). Nasal obstruction index was calculated. Results of mometasone furoate nasal spray 100 microgram/day used once daily at the interval of 8 weeks and 12 weeks were analysed using statistical tests.
Results: A statistically significant reduction in nasal obstruction index and other symptoms were noted at the end of third month follow up.
Conclusions: Mometasone furoate nasal spray caused improvements in outcomes of nasal obstruction, snoring, total nasal symptoms, ear symptoms and overall quality of life.
Demain JG, Goetz DW. Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone. Pediatrics. 1995;95(3):355-64.
Chohan A, Lal A, Chohan K, Chakravarti A, Gomber S. Systematic review and meta-analysis of randomized controlled trials on the role of mometasone in adenoid hypertrophy in children. Int J Pediatr Otorhinolaryngol. 2015;79(10):1599-608.
Minshall E, Ghaffar O, Cameron L, O’Brein F, Quinn H, Rowe-Jones J, et al. 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.
Schenkel EJ, Skoner DP, Bronsky EA, Miller SD, Pearlman DS, Rooklin A et al. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics. 2000;105(2):22.
Boner AL. Effects of intranasal corticosteroids on the hypothalamic-pituitary-adrenal axis in children. J Allergy Clin Immunol. 2001;108(1):32-9.
Szefler SJ. Pharmacokinetics of intranasal corticosteroids. J Allergy Clin Immunol. 2001;108(1):26-31.
Passali D, Spinosi MC, Crisanti A, Bellussi LM. Mometasone furoate nasal spray: a systematic review. Multidiscip Respir Med. 2016;11(1):18.
Paradise JL, Bernard BS, Colborn DK, Janosky JE. Assessment of adenoidal obstruction in children: clinical signs versus roentgenographic findings. Pediatrics. 1998;101(6):979-86.
Torretta S, Marchisio P, Esposito S, Cappadona M, Fattizzo M, Pignataro L. Diagnostic accuracy of the nasal obstruction index in detecting adenoid hypertrophy in children without allergy. Int J Pediatr Otorhinolaryngol. 2011;75(1):57-61.
Hultcrantz E, Harder L, Harder H, Zetterlund EL, Roberg K. To treat snoring with nasal steroids–effects on more than one level? Acta Otolaryngol. 2010;130(1):124-31.
Bhat VK, Razi AM, Kumar VB. Steroid nasal spray versus curettage adenoidectomy in school children-a randomized controlled trial. J Otolaryngol ENT Res. 2017;8(5):259.
Sobhy TS. Role of intranasal steroid in the prevention of recurrent nasal symptoms after adenoidectomy. Int J Otolaryngol. 2013.
Bhargava R, Chakravarti A. Role of mometasone furoate aqueous nasal spray for management of adenoidal hypertrophy in children. J Laryngol Otol. 2014;128(12):1060-6.