Long-term follow-up of children undergoing topical intranasal steroid therapy for adenoidal hypertrophy
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Published on: June 20, 2018
Marco Berlucchi1, Luisa Valetti, Giovanni Parrinello
1Department of Pediatric Otorhinolaryngology, Spedali Civili, Piazza Spedali Civili 1, 25123 Brescia, Italy. marco.berlucchi@tin.it
Insights
Long-term use of mometasone furoate nasal spray in children with adenoid hypertrophy can lead to significant symptom improvement. Discontinuing treatment may necessitate surgery, while consistent use offers sustained benefits for nasal obstruction.
Area of Science:
- Pediatric Otolaryngology
- Allergy and Immunology
- Pharmacology
Background:
- Chronic obstructive nasal symptoms in children are often linked to adenoid hypertrophy.
- Intranasal steroids have shown short-term efficacy for these symptoms.
- Long-term outcomes of intranasal steroid therapy for pediatric adenoidal hypertrophy remain understudied.
Purpose of the Study:
- To evaluate the long-term utility of mometasone furoate aqueous nasal spray for maintenance therapy in children with adenoidal hypertrophy.
- To compare outcomes based on adherence to maintenance therapy and need for surgical intervention.
Main Methods:
- A cohort of children with adenoidal hypertrophy, previously treated successfully with mometasone for 4 months, was followed for a mean of 28 months.
- Participants were categorized into three groups based on therapy continuation and surgical outcomes.
- Clinical and endoscopic evaluations were compared to initial post-treatment assessments.
Main Results:
- Children who stopped therapy (Group A) experienced symptom worsening and required adenoidectomy.
- Children who continued therapy but still needed surgery (Group B) showed no change in nasal symptoms or adenoid size.
- Children who consistently used the nasal spray without surgery (Group C) demonstrated significant further improvement in symptoms and nasal obstruction.
Conclusions:
- This study provides the first long-term follow-up data on mometasone furoate nasal spray for pediatric adenoidal hypertrophy.
- Discontinuation of maintenance therapy is associated with a higher likelihood of surgical intervention.
- Consistent, long-term administration of mometasone furoate nasal spray can lead to sustained positive clinical outcomes.
Background:
Encouraging results concerning chronic obstructive nasal symptoms due to adenoid in pediatric population were reported by use of intranasal steroid for short period. Up to now, no data are available about outcomes of such therapy after long-term follow-up. We evaluated the utility of mometasone furoate aqueous nasal spray in children with adenoidal hypertrophy in long-term maintenance therapy.
Methods:
All children affected by adenoidal hypertrophy and undergoing successful mometasone treatment for 4 months in a preceding trial were reassessed after a mean follow-up of 28 months. Based on the duration of maintenance therapy and eventual adenoid surgical treatment, three subgroups were identified: (1) children voluntarily suspending maintenance therapy and requiring surgery (Group A); (2) children continuing maintenance therapy but undergoing surgery (Group B); and (3) children continuing maintenance therapy but not undergoing surgery (Group C). Clinical and endoscopic evaluation in each group was compared to the assessment performed after the first 4 months of treatment.
Results:
Six patients (Group A) voluntarily suspended maintenance therapy and underwent adenoidectomy. Either the overall symptom score or choanal obstruction of this group worsened compared to the previous trial. Adenoidal surgery was performed in another three children (Group B) for ear disease. Chronic obstructive nasal symptoms and adenoid size were unchanged compared to the preceding study. Finally, 12 patients were in Group C. The overall symptom score and choanal obstruction of this group showed a further significant improvement at this stage.
Conclusions:
This study describes the first long-term follow-up of children undergoing mometasone furoate aqueous nasal spray treatment for adenoidal hypertrophy. Voluntary suspension of maintenance therapy favors surgery of this disorder, whereas its regular administration may lead to successful results.
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