Decreased frequency of adenoidectomy by a 12-week nasal budesonide treatment

Abstract

ObjectiveThere is little evidence on the role of topical budesonide in reducing the frequency of adenoidectomy, although it was reported that topical budesonide can effectively ameliorate the symptoms of adenoid hypertrophy (AH). This study was aimed to investigate the possibility and safety of alternatives to adenoidectomy with a 12-week treatment with nasal budesonide.Materials and methodsOne hundred patients with AH were randomized to receive either a double-blind budesonide (1 mg once daily) or placebo treatment for 2 weeks by transnasal nebulization. A further 12-week open study, budesonide spray (64 μg per nostril at bedtime) was administered to the treatment group. During the final 12 weeks of follow-up, the frequency of adenotonsillectomy, side effects, the degree of nasal obstruction, nasal discharge, and snoring were assessed.ResultsOut of the 100 total enrolled patients, 92 children with AH completed the study. After the 2-week treatment with transnasal budesonide nebulization, the symptoms of AH significantly decreased compared to the control group. Responders (n=26) who had initially improved showed significantly decreased symptoms of AH, and the frequency of adenotonsillectomy during the follow-up (14 and 26 weeks) was compared with that of the control group and non-responders (n=21) who did not respond to the initial 2-week budesonide therapy. The 12-week nasal budesonide treatment did not suppress the growth rate of children’s height or cause other side effects.ConclusionAH children who had improved after an initial 2-week budesonide therapy can achieve clinical improvements and decreased frequency of adenoidectomy following the therapy with a 12-week treatment with nasal budesonide.

Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

“…In the study by Hong et al, [115] all children in the treatment group showed a significant reduction in the nasal obstruction index (NOI) compared to controls. The significant difference of NOI between the two groups of children was confirmed after 12 weeks of open treatment (p < 0.001).…”

“…Four 4 months later, 77.2% of subjects from the treated group were excluded from the surgery list, while all the non-treated subjects underwent surgery. The second study [115], is a double-blind trial which after the first 2 weeks shifted to an open study for 12 weeks. Fifty children aged 6-8 years, with AH grade > 2 and AHI > = 2/h, were treated with budesonide and 50 children used physiological solution.…”

Treatment of hypertrophy of adenoids. Balancing between adenotomy and medication

“…Операції на аденоїдах і мигдаликах належать до дуже поширених, проте останнім часом їхня частота зменшилася з появою альтернативних методів лікування разом із наявними короткотерміновими ризиками хірургічного лікування [4,14,20,30,43,54,79]. Можна обміркувати призначення медикаментозного лікування, яке є альтернативою хірургічному, безпечним і надає тривале полегшення при обструкції верхніх дихальних шляхів [48].…”

“…Деякі дослідження довели, що будесонід пригнічує проліферацію лімфоїдної тканини in vitro у дітей з ОСАС, а 6-тижневе лікування ендоназальним будесонідом ефективно зменшує важкість ОСАС [54,55]. Проте невідомо, чи довготривале лікування ендозанальним будесонідом, який має істотну системну біодоступність, може вплинути на ріст дітей і зменшити частоту операцій серед дітей з ГА [48]. Ендоназальний беклометазон також має високу системну біодоступність, що не дає можливості призначати його довшим курсом та маленьким дітям з огляду на високий ризик системних побічних ефектів.…”

Identification and Detection of Pathogenic Bacteria in Adenoid Tissue of Adenoidectomized Children: Emergence of Staphylococcus aureus as the Most Prevalent Pathogen

“…Adenoid hypertrophy can lead to the nasopharynx obstruction and cause symptoms including snoring, Rhinorrhea, nasal congestion, mouth breathing, halitosis, hyponasal speech, restless sleep, hypersomnolence, and enuresis. It also plays an important role in chronic rhinosinusitis and middle ear infection with effusion (6). In most cases, the removal of a local reservoir of pathogenic microbiota such as adenoid and tonsils decreases the clinical signs and symptoms of affected patients (7).…”