Beruflich Dokumente
Kultur Dokumente
Associate Professor, Department of ENT & Head Neck Surgery, MOSC Medical College Hospital,
Kolenchery, Kerala, India, 2Assistant Professor, Department of ENT & Head Neck Surgery, MOSC
Medical College Hospital, Kolenchery, Kerala, India, 3Professor & Head, Department of ENT & Head
Neck Surgery, MOSC Medical College Hospital, Kolenchery, Kerala, India
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Corresponding Author: Dr. Asha Annie Abraham, Department of ENT & Head Neck Surgery,
MOSC Medical College Hospital, Kolenchery - 682 311, Kerala, India. Phone: +91-9544366187.
E-mail: drashasam@hotmail.com
Abstract
Introduction: Adenoid hypertrophy is a common disease in childhood causing nasal symptoms. Encouraging results were
reported by the use of intranasal steroids with or without montelukast. Here, we evaluated the effectiveness of intranasal
Fluticasone spray coupled with oral montelukast in the treatment of adenoid hypertrophy.
Aims and Objectives: The aim of our study was to assess the efficacy of intranasal steroid spray followed by oral montelukast
in children with adenoid hypertrophy. This mode of treatment can be considered as an alternative to adenoidectomy weighing
the risk-benefit ratio in terms of anesthetic and operative complications of adenoidectomy.
Materials and Methods: A total of 30 children in the age group of 4-7 years of both genders who attended the ENT department
with symptoms related to adenoid hypertrophy were included in the study. Based on the history and symptoms, nasopharyngeal
airway was evaluated by lateral neck radiograph, fiberoptic nasal endoscopy and computed tomography nasopharynx.
Management was in the form of intranasal fluticasone spray 50 g twice a day for 4 weeks followed by 50 g daily at night for
another 4 weeks. After 8 weeks of treatment with intranasal steroid spray, patient was put on oral montelukast 4 mg at night
for another 2 months. All children were reviewed at 1-month interval. End result was tabulated based on the post-treatment
symptomatic relief; follow-up neck radiographs and fiberoptic nasal endoscopy.
Results: From our study, 80% of the children had relief of their symptoms in 4 months of treatment with intranasal steroid spray
followed by oral montelukast, thus alleviating the need for surgery.
Conclusion: This study proves the effectiveness of a combination of intranasal steroid spray and oral montelukast in the
treatment of adenoid hypertrophy in children thus providing an effective alternative to surgical treatment.
Keywords: Adenoid hypertrophy, Fluticasonepropionate, Montelukast
INTRODUCTION
Adenoid is a lymphoid tissue located in the roof and
posterior wall of the nasopharynx. Normally being
a resistance center against respiratory infections, it
may itself become a source of recurrent and chronic
infection. Adenoid hypertrophy is a common childhood
disease and cause symptoms such a mouth breathing,
nasal obstruction, hyponasal speech, snoring as well as
obstructive sleep apnea and otitis media with effusion
(OME).1 Adenoid hypertrophy was graded as Grade 1
only top segment of choana is obstructed (<25%),
Grade 2 upper half of choana is obstructed (<50%),
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Before treatment
After treatment
0.5
0
DISCUSSION
The successful use of intra nasal steroid spray in children
with adenoid hypertrophy was first introduced by
Demain and Goetz.4 Although it is not yet clear by which
mechanism the steroids reduce the nasal airway obstruction,
there are some plausible theories. Some of these include
reduction of adenoid size directly by lympholytic effect,
the anti-inflammatory effect of steroids help to reduce
the adenoidal and nasopharyngeal inflammation, or they
reduce the possibility of the adenoid acting as an infection
reservoir.5 Studies which prove the fact that adenoid tissue
includes many glucocorticoid receptors and messenger
RNA strengthen the probable mechanism.6 The importance
lies in the proper application of the nasal spray. In our
study, after 8 weeks of treatment with intranasal steroid
spray, 60% of the patients had complete relief from their
symptoms.
Cysteinyl leukotrienes (Cys LT) are endogenous mediators
of inflammation and play an important role in allergic
Outcome
3
Complete recovery
3
24
Surgery
No surgery
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REFERENCES
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3.
4.
CONCLUSION
This study proves the effectiveness of intranasal steroid
spray used in a proper way and oral montelukast in the
treatment of adenoid hypertrophy in children. This
provides an effective alternative to surgical treatment
especially in children whose parents are reluctant to surgical
modality of treatment.
5.
6.
7.
How to cite this article: Abraham AA, Markose PA, Rony KMT, George MS. Intranasal Steroid Spray and Montelukast in the Management
of Adenoid Hypertrophy in Children. Int J Sci Stud 2014;2(6):62-65.
Source of Support: Nil, Conflict of Interest: None declared.
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