Evaluation of the effects of montelukast, mometasone furoate, and combined therapyon adenoid size: a randomized, prospective, clinical trial with objective data

Abstract

IntroductionAdenoids are pyramid-shaped enlarged masses of lymphoid tissue in the nasopharynx (1), and they form an important part of Waldeyer's tonsillar ring. Although the adenoids are very small at birth, they may exhibit growth in the first 4 years of life, depending on the development of the immune system (2).The incidence of adenoid hypertrophy is 2%-3% in children (2). Untreated adenoid hypertrophy may lead to difficulty in breathing through the nose, snoring, sleep apnea, nasal speech, ear problems, growth retardation, and craniofacial anomalies (1,2). Various methods are used for the diagnosis of adenoid hypertrophy including lateral head radiography, videofluoroscopy, palpation, and nasal endoscopy; the most recent methods are lateral radiographs and nasal endoscopy (3).Adenoidectomy is a commonly performed procedure in children that may cause complications such as early or late bleeding (4%-5%), adenoid tissue recurrence (10%-20%), and postoperative respiratory problems (27%) (2). In addition, anesthesia risks are also among the factors that should be taken into account (4). As such, medical therapy alternatives to adenoidectomy are important and must be tried before surgery.Leukotrienes are inflammatory mediators found in the respiratory system and these play a role in several allergic childhood diseases (5). Cysteinyl leukotriene receptor-1 mediates the inflammatory pathway and has been found in high rates in postoperative adenotonsillar tissues in pediatric patients with obstructive sleep apnea (6-8). Montelukast is an effective and reliable cysteinyl leukotriene receptor antagonist that can be used in oral form and has high bioavailability. It was approved by the United States Food and Drug Administration (FDA) for preventive therapy against the inflammatory component in asthma and allergic rhinitis in children aged over 1 year. Background/aim: The incidence of adenoid hypertrophy is 2%-3% in children. Adenoidectomy is a commonly performed procedure in children that may cause complications such as early or late bleeding (4%-5%), recurrence of adenoid tissue (10%-20%), and postoperative respiratory problems (27%). Therefore, medical therapy alternatives to adenoidectomy are important and must be tried before surgery. In this study, we investigated the efficacy of mometasone furoate, montelukast, and a combination of these drugs in pediatric patients with adenoid hypertrophy who were scheduled for reduction with medical therapy after not being recommended for surgery. Materials and methods:The study included 120 children with adenoid hypertrophy aged between 4 and 10 years. The patients were randomized into 4 separate groups, with 30 in each group. Group 1 received 100 µg of mometasone furoate per day, group 2 received 4/5 mg (for age) montelukast per day, and group 3 received mometasone furoate + montelukast. Medical therapy continued for 3 months in the treatment groups. Group 4, which comprised patients with mild symptoms, received no treatment and was the control group. The pre-and posttreatment ...

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

“…Two more recent RCTs reported a significant effect of ICS on the reduction of adenoid tissue and the degree of hypertrophy [111,112]. Finally, in a nonrandomized study, 35 children who had undergone adenoidectomy were treated with MF for 6 months and starting 3 weeks after wound healing compared to 35 children undertaking local saline solution [113].…”

Rhinitis 2020: A practice parameter update

“…Medical therapy includes topical nasal corticosteroids, which are found to be effective with high-quality evidence, montelukast, or a combination of both; however, data suggest that single drug therapy may be just as effective as the combination. [230][231][232] When medical therapy fails, surgical removal should be considered. Young age and apnea hypopnea index >1 increase the likelihood that surgery will be necessary.…”

The Effect of Mometasone Nasal Spray and/or Montelukast on Adenoid Size

“…Tuhanıoğlu et al studied the effect of MF, MO, or their combination on the size of adenoid, measured by lateral X-ray of the neck, but they didn't study the recurrence after cessation of treatment. They found similar improvement in all groups with no statistical difference [22] . Our results partially agree with their findings, as we found a similar improvement during treatment, but the effect is lasting after stopping the treatment for the groups taking MF or MF and MO, but not MO alone.…”

“…In literature, there are few papers regarding the effect of MO on obstructive adenoids. Some studies suggest using both MF and MO together [21,22] .…”