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Alanazi F, Alruwaili M, Alanazy S, Alenezi M. Efficacy of montelukast for adenoid hypertrophy in paediatrics: A systematic review and meta-analysis. Clin Otolaryngol 2024; 49:417-428. [PMID: 38700144 DOI: 10.1111/coa.14169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/28/2023] [Accepted: 04/13/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Leukotrienes play a significant role in the pathogenesis of adenoid hypertrophy (A.H.). Therefore, we aimed to analyse the role of montelukast, a leukotriene receptor antagonist, alone or in combination with mometasone, a potent local intranasal steroid, for the treatment of A.H. METHODS Participants were children with A.H. were treated with montelukast alone or montelukast and mometasone furoate. The main outcome measures were effect of montelukast on clinical symptoms of A.H. A literature review was conducted using online search engines, Cochrane Library, PubMed, Web of Science and Scopus, for randomized clinical trials assessing children with A.H. treated with montelukast alone or montelukast and mometasone furoate. Seven randomized clinical trials (RCTs) were included with 742 children. RESULTS Our study reveals that montelukast alone or in combination with intranasal mometasone furoate significantly improves clinical symptoms of adenoid hypertrophy such as snoring, sleeping disturbance, mouth breathing and A/N ratio. Montelukast was superior to placebo in decreasing snoring (SMD = -1.00, 95% CI [-1.52, -0.49]), sleep discomfort (SMD = -1.26, 95% CI [-1.60, -0.93]), A/N ratio (MD = -0.11, 95% CI [-0.14, -0.09]) and mouth breathing (SMD = -1.36, 95% CI [-1.70, -1.02]). No difference was detected between montelukast and mometasone versus mometasone alone in snoring (SMD = -0.21, 95%CI [-0.69, 0.27]); however, the combination group was superior to the mometasone alone in mouth breathing (SMD = -0.46, 95% CI [-0.73, -0.19]). CONCLUSIONS The limitation of studies included a small sample size, with an overall low to medium quality. Thus, further larger, higher-quality RCTs are recommended to provide more substantial evidence.
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Affiliation(s)
- Farhan Alanazi
- Department of Otolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
- Department of Otolaryngology Head and Neck Surgery, Prince Mohammed Medical City, Al Jouf, Kingdom of Saudi Arabia
| | - Moteb Alruwaili
- Department of Otolaryngology Head and Neck Surgery, King Abdulaziz Specialist Hospital, Al Jouf, Kingdom of Saudi Arabia
| | - Sultan Alanazy
- Department of Surgery, Ears Nose and Throat Unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Mazyad Alenezi
- Department of Otolaryngology Head and Neck Surgery, Collage of Medicine, Qassim University, Buriyadh, Kingdom of Saudi Arabia
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Joseph G, Georgi C, Kress P. [Does a preoperative coagulation sheet change the postoperative bleeding rate after adenoidectomy?]. Laryngorhinootologie 2024; 103:358-364. [PMID: 38134906 DOI: 10.1055/a-2209-6169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
BACKGROUND Adenoidectomy (AT) represents one of the first and most common surgeries in childhood. A joint statement of the German Society for Anesthesiology & Intensive Care Medicine as well as Pediatric & Adolescent Medicine and Otolaryngology, Head and Neck Surgery was published in 2006 to prevent of a possibly life-threatening postoperative bleeding after AT in Child age. Routine blood sampling should be avoided during preoperative preparations and instead a standardized coagulation questionnaire (GB) should be performed to clarify a coagulation disorder (GS). If the GB is abnormal, there is an indication for coagulation diagnostics (GD). MATERIALS AND METHODS This unicenter, nonrandomized, retrospective study compared the rate of bleeding after AT and Re-AT without (2011 to early 2014) and with (early 2014 to 2018) the use of a GB. 2633 children aged one to six years, were included in the statistical analysis to assess whether the introduction of GB in early 2014 was able to reduce the rate of bleeding after AT and Re-AT. RESULTS Of the 2633 children, 1451 had GB and 1182 did not. Without GB, there was a bleeding rate of 0.83% and 2,08% with GB. 174 GB were abnormal and 169 GD were performed, 164 of these were unremarkable, 2 resulted in a confirmed mild type 1 von Willebrand syndrome as well as 2 suspected vWS and 1 suspected factor VII deficiency. The sensitivity of the GB was 16% and the specificity was 87.5%. The positive predictive value was 2.8% and the negative predictive value was 98%. CONCLUSION The GB is a tool for detecting possible GS, but is not useful for reducing the rate of postoperative bleeding.
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Affiliation(s)
- Georges Joseph
- HNO / Kopf & Halschirurgie, Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier, Germany
| | - Carina Georgi
- HNO / Kopf & Halschirurgie, Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier, Germany
| | - Peter Kress
- HNO / Kopf & Halschirurgie, Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier, Germany
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Teng ZP, Li Q, Shen XF. Torus Tubarius Hypertrophy After Adenoidectomy. EAR, NOSE & THROAT JOURNAL 2023:1455613231199676. [PMID: 37700607 DOI: 10.1177/01455613231199676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Backgrounds: Adenoidectomy is widely used to cure sleep-disordered breathing symptoms in children, torus tubarius hypertrophy (TTH) after adenoidectomy causing recurred snoring, sleep apnea, nasal obstruction, or mouth breathing was rarely reported, and the causes of TTH are still unclear. Objectives: To report a rare complication TTH after adenoidectomy, and the features of TTH. Material and Methods: A total of 36 pediatric patients with TTH diagnosed by our hospital from January 2017 to 2023 were included in this study. All children were treated conservatively for a month at first, and 13 patients underwent partial resection of TTH. The influencing factors (sex, age, allergic rhinitis [AR], and first operation way) were analyzed. Results: There were 36 patients with TTH: 27 boys and 9 girls. The age of the first operation ranged from 20 to 63 months, and the interval time of TTH after operation ranged from 3 to 55 months. Thirteen patients underwent partial resection of TTH. Thirteen children had definite symptoms and signs of AR. Conclusions and Significance: TTH is a rare complication after adenoidectomy, which is common in male children (75.0%) and in patients who took adenoidectomy before the age of 5 years (94.4%). TTH can occur as early as 3 months after adenoidectomy. AR and the operation way might have relationships with TTH.
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Affiliation(s)
- Zhi-Pan Teng
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Jiangsu, PR China
| | - Qi Li
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Jiangsu, PR China
| | - Xiao-Fei Shen
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Jiangsu, PR China
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Roushdy MM, jalil AAA, Saeed AM. Mometasone Furoate Use for Recurrent Adenoid Hypertrophy: Randomized Controlled Clinical Trial. Indian J Otolaryngol Head Neck Surg 2023; 75:1639-1646. [PMID: 37636767 PMCID: PMC10447813 DOI: 10.1007/s12070-023-03539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/26/2023] [Indexed: 08/29/2023] Open
Abstract
Background& Objective: Adenoid hypertrophy (AH) in children is one of the most causes of nasal obstruction and is associated with many nasal and respiratory symptoms. Till now, surgery is the main option for managing the associated symptom of AH. The intranasal steroid has an effective role in the control of allergic rhinitis and associated AH. This work aimed to assess the effects of local mometasone on recurrent AH in children. Patients& Methods: A randomized controlled trial enrolled 39 patients aged between 2 and 15 years with recurrent AH. Those patients were randomly subdivided into three groups; group (A) received topical mometasone furoate (MF), group (B) did not receive any medication, and group (C) received topical normal saline. All groups were followed up for 8 weeks. Results: Patients who received Mometasone furoate had temporary relief of adenoid hypertrophy-related symptoms (84.6%) in comparison to the control group and placebo group during the duration of treatment. After cessation of treatment with local steroids, all cases experienced symptoms caused by adenoid hypertrophy, and by the end of the third month of follow up all cases underwent adenoidectomy. Conclusion: Mometasone furoate can temporarily reduce the adenoid size, reducing symptoms related to adenoid hypertrophy.
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Affiliation(s)
| | | | - Ahmed Mahmoud Saeed
- The Department of otolaryngology, Student Hospital, Assiut University, 71515 Assiut, Egypt
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Zwierz A, Masna K, Domagalski K, Burduk P. 150th Anniversary of global adenoid investigations: unanswered questions and unsolved problems. Front Pediatr 2023; 11:1179218. [PMID: 37520046 PMCID: PMC10375715 DOI: 10.3389/fped.2023.1179218] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Although the problem of adenoid hypertrophy (AH) has been diagnosed and treated by doctors and scientists from around the world for the last 150 years, there is still no consensus regarding appropriate diagnosis, conservative treatment options, and qualification for surgery. This manuscript presents current knowledge on these issues and compares diagnostic methods and the effectiveness of treatment options. Factors that may influence the obtained treatment results are also described, and a questionnaire is proposed to compare the results of treatment. The objective of drawing attention to this problem is to obtain better results from conservative treatment in the future and better-qualified patients for surgical treatment.
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Affiliation(s)
- Aleksander Zwierz
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Krystyna Masna
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Krzysztof Domagalski
- Department of Immunology, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, Torun, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Baruah B, Gupta A, Kumar A, Kumar A. The Role of Montelukast Sodium in Children with Adenoid Hypertrophy - A Comparative Study. Indian J Otolaryngol Head Neck Surg 2023; 75:306-310. [PMID: 37275091 PMCID: PMC10235367 DOI: 10.1007/s12070-022-03167-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Adenoid Hypertrophy (AH) results in symptoms ranging from mild nasal obstruction to the dangerous obstructive sleep apnoea. Normally for such patients Adenoidectomy with or without Tonsillectomy is carried out. However complications like haemorrhage and recurrence of adenoid tissue are common. Thus, non-surgical therapies have attracted considerable attention as an alternative strategy. The present study is aimed at evaluating the effect of oral Montelukast, a cysteinyl- leukotriene receptor antagonist, in children with AH. Materials and Methods Sixty children aged between 6 and 12 years with adenoid hypertrophy were randomly divided into two groups of thirty each. The study group was prescribed Tablet Montelukast 5 mg daily for 12 weeks while the control group received matching placebo. A questionnaire based upon the severity of the symptoms as well as the Adenoid Nasopharynx ratio (A/N), as measured via X-ray Adenoids and the Nasal endoscopic scores done before and after treatment (at 3 months) in the two groups were taken into consideration . Results The Mann Whitney Test which was used found no distinction in snoring, sleep discomfort and mouth breathing between the two groups before the start of treatment. But a significant difference was indeed observed between the two groups after treatment in case of snoring (P < 0.006), sleep discomfort(P < 0.001) and mouth breathing (P < 0.001). Conclusion Oral Montelukast therapy is seen to be effective not only in the reduction of the size of adenoids but also in improvement of the overall symptoms and can thus be considered as a viable alternative .
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Affiliation(s)
- Binayak Baruah
- Tata Main Hospital, Bistupur, 831001 Jamshedpur, Jharkhand India
| | - Ajay Gupta
- Tata Main Hospital, Bistupur, 831001 Jamshedpur, Jharkhand India
| | - Abhijit Kumar
- Tata Main Hospital, Bistupur, 831001 Jamshedpur, Jharkhand India
| | - Alok Kumar
- Tata Main Hospital, Bistupur, 831001 Jamshedpur, Jharkhand India
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Duse M, Santamaria F, Verga MC, Bergamini M, Simeone G, Leonardi L, Tezza G, Bianchi A, Capuano A, Cardinale F, Cerimoniale G, Landi M, Malventano M, Tosca M, Varricchio A, Zicari AM, Alfaro C, Barberi S, Becherucci P, Bernardini R, Biasci P, Caffarelli C, Caldarelli V, Capristo C, Castronuovo S, Chiappini E, Cutrera R, De Castro G, De Franciscis L, Decimo F, Iacono ID, Diaferio L, Di Cicco ME, Di Mauro C, Di Mauro C, Di Mauro D, Di Mauro F, Di Mauro G, Doria M, Falsaperla R, Ferraro V, Fanos V, Galli E, Ghiglioni DG, Indinnimeo L, Kantar A, Lamborghini A, Licari A, Lubrano R, Luciani S, Macrì F, Marseglia G, Martelli AG, Masini L, Midulla F, Minasi D, Miniello VL, Del Giudice MM, Morandini SR, Nardini G, Nocerino A, Novembre E, Pajno GB, Paravati F, Piacentini G, Piersantelli C, Pozzobon G, Ricci G, Spanevello V, Turra R, Zanconato S, Borrelli M, Villani A, Corsello G, Di Mauro G, Peroni D. Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases. Ital J Pediatr 2021; 47:97. [PMID: 33882987 PMCID: PMC8058583 DOI: 10.1186/s13052-021-01013-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. METHODS Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. RESULTS The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. CONCLUSIONS We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research.
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Affiliation(s)
- Marzia Duse
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.
| | | | | | | | - Lucia Leonardi
- Maternal, Infantile and Urological Sciences Department, Sapienza University, Rome, Italy
| | - Giovanna Tezza
- Pediatric Department, Franz Tappeiner Hospital, Meran, Italy
| | - Annamaria Bianchi
- Pediatric Unit, Department of Women's and Children's Health, San Camillo Forlanini Hospital, Rome, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, University "Luigi Vanvitelli", Regional Centre of Pharmacovigilance Campania, Naples, Italy
| | - Fabio Cardinale
- Pediatric and Emergency Unit Giovanni XXIII Pediatric Hospital University of Bari, Bari, Italy
| | | | - Massimo Landi
- Family Pediatrician Local Health Unit, Turin and IRIB-CNR, Palermo, Italy
| | | | | | - Attilio Varricchio
- Allergy Centre, Department of Pediatric Sciences IRCCS Gaslini Institute, Genova, Italy
| | - Anna Maria Zicari
- Departmental Operative Unit of Diagnostic and Surgical Videoendoscopy of the Upper Airways, Asl Napoli 1 Center, Naples, Italy
| | - Carlo Alfaro
- Maternal, infantile and urological sciences Department, Pediatric Allergic Unit, Sapienza University, Rome, Italy
| | - Salvatore Barberi
- Paediatrics Unit, Reunited Hospitals Castellammare of Stabia, Naples, Italy
| | | | | | - Paolo Biasci
- Pediatric Unit San Giuseppe Hospital, Empoli, Florence, Italy
| | - Carlo Caffarelli
- Family Paediatrician, Local Health Unit, FIMP National President, Livorno, Italy
| | - Valeria Caldarelli
- Department of Obstetrics Gynaecology and Pediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Capristo
- Pediatric Unit, Department of Mother and Child, AUSL-IRCCS, Reggio Emilia, Italy
| | - Serenella Castronuovo
- Department of Woman, Child and of General and Specialized Surgery, University "Luigi Vanvitelli", Naples, Italy
| | - Elena Chiappini
- Family Paediatrician Local Health Unit Nettuno-Anzio, Rome, Italy
- Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department Of Health Sciences, University of Florence, Florence, Italy
| | - Renato Cutrera
- Pediatric Pulmonology Unit, Academic Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanna De Castro
- Departmental Operative Unit of Diagnostic and Surgical Videoendoscopy of the Upper Airways, Asl Napoli 1 Center, Naples, Italy
| | | | - Fabio Decimo
- Pediatric Unit, Department of Mother and Child, AUSL-IRCCS, Reggio Emilia, Italy
| | | | - Lucia Diaferio
- Department of Paediatrics, Aldo Moro University of Bari, Bari, Italy
| | - Maria Elisa Di Cicco
- Paediatrics Unit, University Hospital of Pisa, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Caterina Di Mauro
- General Paediatrics and Paediatric Acute and Emergency Unit, University Hospital San Marco, University of Catania, Catania, Italy
| | - Cristina Di Mauro
- Department of Experimental Medicine, University "Luigi Vanvitelli", Regional Centre of Pharmacovigilance Campania, Naples, Italy
| | - Dora Di Mauro
- Family Paediatrician Local Health Unit, Ausl, Modena, Italy
| | | | - Gabriella Di Mauro
- Department of Experimental Medicine, University "Luigi Vanvitelli", Regional Centre of Pharmacovigilance Campania, Naples, Italy
| | - Mattia Doria
- Primary Care Paediatrician, Local Health Unit, National Secretary for the Scientific and Ethical Activities of FIMP, Chioggia, Italy
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit and Neonatal Accompaniment Unit, University Hospital San Marco, University of Catania, Catania, Italy
| | - Valentina Ferraro
- Unit of Paediatric Allergy and Respiratory Medicine Women's and Children's Health Department, University Hospital Padua, Padua, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, AOU and University of Cagliari, Monserrato (CA), Italy
| | - Elena Galli
- Pediatric Allergy Unit, Department of Paediatric Medicine, S. Pietro Hospital Fatebenefratelli, Rome, Italy
| | - Daniele Giovanni Ghiglioni
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, UOSD Paediatric Highly Intensive Care Unit, Milan, Italy
| | - Luciana Indinnimeo
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ahmad Kantar
- Pediatric Asthma and Cough Center Istituti Ospedalieri Bergamaschi, Gruppo Ospedaliero San Donato, Ponte San Pietro, Bergamo, Italy
| | | | - Amelia Licari
- Paediatric and Neonatology Unit Santa Maria Goretti Hospital, Department of Pediatrics, University of Pavia, Pavia, Italy
| | - Riccardo Lubrano
- Paediatric and Neonatology Unit Santa Maria Goretti Hospital, Department of Pediatrics, Sapienza University, Rome, Italy
| | - Stefano Luciani
- Pediatric and Neonatal Intensive Care Unit Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Francesco Macrì
- Allergist Pediatrician National Secretary of Italian Federation for Medical Scientific Societies (FISM), Rome, Italy
| | - Gianluigi Marseglia
- Paediatric and Neonatology Unit Santa Maria Goretti Hospital, Department of Pediatrics, University of Pavia, Pavia, Italy
| | | | - Luigi Masini
- Pediatric Pulmonology and Subintensive Respiratory Therapy Unit Department of Pediatrics Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Fabio Midulla
- Maternal, Infantile and Urological Sciences Department, Sapienza University, Rome, Italy
| | - Domenico Minasi
- Pediatric Unit Great Metropolitan Hospital Reggio Calabria, Reggio Calabria, Italy
| | - Vito Leonardo Miniello
- Department of Biomedical Science and Human Oncology, University of Bari, Children's Hospital "Giovanni XXIII", Bari, Italy
| | | | | | | | - Agostino Nocerino
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, Naples, Italy
| | - Elio Novembre
- Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | | | - Francesco Paravati
- Department of Human Pathology in Adult and Development Age, Pediatric Unit, University of Messina, Messina, Italy
| | | | - Cristina Piersantelli
- Paediatric Section Department of Surgery, Dentistry, Paediatrics and Gynaecology University of Verona, Verona, Italy
| | - Gabriella Pozzobon
- Family Pediatrician, Paediatric Allergy, Local Health Unit TO1, Turin, Italy
| | | | | | - Renato Turra
- Family Pediatrician Local Health Unit, Caselle Torinese, Vicenza, Italy
| | | | - Melissa Borrelli
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Alberto Villani
- Unit of Pediatric Allergy and Respiratory Medicine Women's and Children's Health Department University Hospital, Padua, Italy
| | | | | | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
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Naqi SA, Ashfaq AH, Umar MA, Karmani JK, Arshad N. Clinical outcome of Montelukast Sodium in Children with Adenoid Hypertrophy. Pak J Med Sci 2021; 37:362-366. [PMID: 33679914 PMCID: PMC7931283 DOI: 10.12669/pjms.37.2.2670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background & Objectives: Generally, the blockage of upper respiratory tract in children is seen with the hypertrophy of adenoids and tonsils. Normally for patients with adenoid hypertrophy (AH), Adenoidectomy with or without Tonsillectomy is carried out, however it has its own complications like haemorrhage and recurrence of adenoid tissue. Consequently, therapeutic approach has increased extraordinary consideration rather than surgical procedure. The inflammatory process proposed for AH has prompted the utilization of anti-inflammatory drugs to treat this issue. The objective of this study was to assess the impacts of Montelukast sodium in children with enlarged adenoids. Methods: A randomized controlled trail was performed from April 2018 to March 2019 in the Otorhinolaryngology clinic of Dr. Akbar Niazi Teaching Hospital, Islamabad. In this randomized, placebo treatment-controlled trial, 60 children aged 4-12 years meeting inclusion criteria were isolated into two groups. The study group was treated with Montelukast sodium 5mg consistently for three months while the control group got placebo treatment for a similar timeframe. A questionnaire was filled by parents/ guardians of every child before and after the intervention to evaluate the severity of sleep discomfort, snoring and mouth breathing. Results: Following 3 months of treatment, significant reduction in size of the adenoids was seen in 76% of study group compared with just 3% of control group getting placebo treatment. Conclusion: Montelukast sodium seems to be effective in the reduction of the size of adenoids and improvement in clinical manifestations. It can be viewed as a viable option in contrast to surgical treatment in children with hypertrophy of adenoids.
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Affiliation(s)
- Syed Ali Naqi
- Prof. Dr. Syed Ali Naqi, FCPS (ENT). Professor & HOD ENT, Islamabad Medical and Dental College, Islamabad Pakistan
| | - Ahmad Hassan Ashfaq
- Dr. Ahmad Hassan Ashfaq, FCPS (ENT). Associate Prof., Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Mumtaz Ahmad Umar
- Dr. Mumtaz Ahmad Umar, FCPS (ENT). Assistant Professor, Islamabad Medical and Dental College, Islamabad Pakistan
| | - Jais Kumar Karmani
- Dr. Jais Kumar Karmani, MD (Medicine). Assistant Professor, Islamabad Medical and Dental College, Islamabad Pakistan
| | - Naveed Arshad
- Dr. Naveed Arshad, M.Phil. (Rehabilitation Sciences). Assistant Professor, Islamabad Medical and Dental College, Islamabad Pakistan
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Ras AE, Hamed MH, Abdelalim AA. Montelukast combined with intranasal mometasone furoate versus intranasal mometasone furoate; a comparative study in treatment of adenoid hypertrophy. Am J Otolaryngol 2020; 41:102723. [PMID: 32950830 DOI: 10.1016/j.amjoto.2020.102723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/07/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate the role of combined therapy using montelukast and intranasal mometasone furoate compared to intranasal mometasone furoate alone in treatment of adenoid hypertrophy regarding efficacy and recurrence rate. METHODS The study included 100 children with adenoid hypertrophy, they were randomly assigned to two groups. Group I (50 patients) received combined therapy using montelukast and mometasone furoate nasal spray. Group II (50 patients) received only mometasone furoate nasal spray. Patients were treated for 3 months and observed for 3 months after stoppage of treatment. Patients were evaluated using symptoms scores, Adenoid/Nasopharyngeal ratio and endoscopic grading of adenoid hypertrophy. RESULTS After 3 months of treatment, group I showed significant better scores of main symptoms than group II; (P = 0.001), (P = 0.019) and (P = 0.008) for rhinorrhea, mouth breathing and snoring respectively. The mean A/N ratio was 52.8 ± 11.3 in group I better than 62.88 ± 12.10 in group II (P < 0.001). Regarding the adenoid hypertrophy grading, significant reduction in size was found in group I in 34 (68%) patients better than in group II in 18 (36%) patients (P = 0.001). After further 3 months of follow up, the mean A/N ratio was 58.46 ± 10.05 in group I better than 66.36 ± 10.46 in group II (P < 0.001). Recurrence occurred in 8 (23.5%) cases out of 34 improved cases in group I better than 10 (55.5%) cases out of 18 cases in group II (P = 0.02). CONCLUSION Combining oral montelukast with intranasal mometasone in treatment of adenoid hypertrophy provided better improvements and less recurrence in comparison with single therapy using intranasal mometasone alone.
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Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Dinakar C, Ellis AK, Finegold I, Golden DBK, Greenhawt MJ, Hagan JB, Horner CC, Khan DA, Lang DM, Larenas-Linnemann DES, Lieberman JA, Meltzer EO, Oppenheimer JJ, Rank MA, Shaker MS, Shaw JL, Steven GC, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Dinakar C, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Khan DA, Lang DM, Lieberman JA, Oppenheimer JJ, Rank MA, Shaker MS, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Finegold I, Hagan JB, Larenas-Linnemann DES, Meltzer EO, Shaw JL, Steven GC. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020; 146:721-767. [PMID: 32707227 DOI: 10.1016/j.jaci.2020.07.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.
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Affiliation(s)
- Mark S Dykewicz
- Section of Allergy and Immunology, Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, School of Medicine, Saint Louis University, St Louis, Mo.
| | - Dana V Wallace
- Department of Medicine, Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - David J Amrol
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC
| | - Fuad M Baroody
- Department of Otolaryngology-Head and Neck Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Timothy J Craig
- Departments of Medicine and Pediatrics, Penn State University, Hershey, Pa
| | - Chitra Dinakar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, Calif
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ira Finegold
- Division of Allergy and Immunology, Department of Medicine, Mount Sinai West, New York, NY
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Department of Medicine, School of Medicine, John Hopkins University, Baltimore, Md
| | - Matthew J Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colo
| | - John B Hagan
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Caroline C Horner
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, School of Medicine, Washington University, St Louis, Mo
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | - Jay A Lieberman
- Division of Pulmonology Allergy and Immunology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Eli O Meltzer
- Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, University of California, San Diego, Calif; Allergy and Asthma Medical Group and Research Center, San Diego, Calif
| | - John J Oppenheimer
- Division of Pulmonary & Critical Care Medicine and Allergic & Immunologic Diseases, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, New Brunswick, NJ; Pulmonary and Allergy Associates, Morristown, NJ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - Marcus S Shaker
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Ghafar MHA, Mohamed H, Mohammad NMY, Mohammad ZW, Madiadipoera T, Wang DY, Abdullah B. Mometasone furoate intranasal spray is effective in reducing symptoms and adenoid size in children and adolescents with adenoid hypertrophy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ghafar MHA, Mohamed H, Mohammad NMY, Mohammad ZW, Madiadipoera T, Wang DY, Abdullah B. Mometasone furoate intranasal spray is effective in reducing symptoms and adenoid size in children and adolescents with adenoid hypertrophy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 71:147-153. [PMID: 31400807 DOI: 10.1016/j.otorri.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/14/2019] [Accepted: 04/26/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The use of mometasone furoate (MF) intranasal spray in treating adenoid hypertrophy (AH) has a variable outcome due the different methods of adenoid size evaluation. The aim of our study was to evaluate the effect of MF intranasal spray in children and adolescents with AH using a reliable and consistent endoscopic evaluation. MATERIAL AND METHOD A prospective interventional study was conducted. Evaluation took place during the first visit (week 0) and second visit (week 12). Symptoms of nasal obstruction, rhinorrhoea, cough and snoring were assessed, and an overall total symptoms score was obtained. A rigid nasoendoscopic examination using a four-grading system of adenoid size from 1 to 4 was performed. Patients were treated with MF intranasal spray for 12 weeks. Patients' aged 7-11-years old used 1 spray in each nostril once daily, while patients aged 12-17 used two sprays in each nostril once daily. Reassessment was carried out during the second visit (week 12). RESULTS A total of 74 patients was recruited. There were significant improvements from week 0 to week 12 in the symptoms' score for nose obstruction, rhinorrhoea, cough, snoring including the total nasal symptoms' score (p<0.001). AH significantly reduced in size from week 0 (2.89±.87) to week 12 (1.88±.83) (p<0.001). CONCLUSION MF intranasal spray is effective in improving the symptoms attributed to AH as well as reducing the adenoid size. MF intranasal spray is advocated as a treatment option before adenoidectomy is considered.
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Affiliation(s)
- Muhammad Hazim Abdul Ghafar
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Hazama Mohamed
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nik Mohd Yunus Mohammad
- Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Zahiruddin Wan Mohammad
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Teti Madiadipoera
- Department of Otorhinolaryngology, Hasan Sadikin Hospital, Faculty of Medicine, Padjadjaran University, Indonesia
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
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