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Montelukast in Adenoid Hypertrophy: Its Effect on Size and Symptoms
Farshid Shokouhi1, Ahmad Meymaneh Jahromi1, Mohamad Reza Majidi2
1Department of Otorhinolaryngology, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.
Insights
Montelukast chewable tablets significantly reduced adenoid size and improved symptoms like snoring and mouth breathing in children with adenotonsillar hypertrophy. This offers a potential non-surgical alternative to adenotonsillectomy.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Pediatric Allergy and Immunology
Background:
- Adenotonsillar hypertrophy (AH) is a common cause of pediatric upper airway obstruction, leading to symptoms like snoring and obstructive sleep apnea.
- Surgical adenotonsillectomy, while typical, carries risks including bleeding and postoperative complications, alongside potential recurrence.
- Non-surgical approaches are sought, with anti-inflammatory mechanisms explored due to the inflammatory basis of AH.
Purpose of the Study:
- To evaluate the efficacy of montelukast, a cysteinyl-leukotriene receptor antagonist, as a non-surgical treatment for adenotonsillar hypertrophy in children.
- To assess the impact of montelukast on adenoid size and related clinical symptoms.
Main Methods:
- A randomized, placebo-controlled trial involving 60 children aged 4-12 years with significant choanal obstruction.
- Participants received either 5 mg of montelukast or a placebo daily for 12 weeks.
- Parental questionnaires assessed sleep discomfort, snoring, and mouth breathing severity before and after treatment.
Main Results:
- Adenoid size decreased in 76% of children treated with montelukast versus 3% in the placebo group.
- Significant improvements were noted in sleep discomfort, snoring, and mouth breathing in the montelukast group.
- The average symptom score decreased from 7.7 to 3.3 in the montelukast group, compared to a change from 7.4 to 6.7 in the placebo group.
Conclusions:
- Montelukast chewable tablets effectively reduce adenoid size in children with AH.
- Montelukast improves clinical symptoms associated with adenotonsillar hypertrophy.
- This medication presents a viable non-surgical alternative to surgical intervention for pediatric adenoid hypertrophy.
Introduction:
Adenotonsillar hypertrophy (AH) is considered the most common cause of upper respiratory tract obstruction among children. It results in a spectrum of symptoms from mouth breathing, nasal obstruction, hyponasal speech, snoring, and obstructive sleep apnea (OSA) to growth failure and cardiovascular morbidity. Adenotonsillectomy is a typical strategy for patients with AH, but may lead to serious complications such as bleeding (4-5%) and postoperative respiratory compromise (27%), especially among young children, as well as recurrence of adenoid tissue (10-20%). Thus, non-surgical therapies have attracted considerable attention as an alternative strategy. The inflammatory mechanism proposed for AH has lead to the use of anti-inflammatory drugs to manage this condition. The present study aimed to evaluate the effect of chewable tablets of montelukast, a cysteinyl- leukotriene receptor antagonist, in children with AH.
Materials And Methods:
Sixty children between the ages of 4-12 years with >75% choanal obstruction on primary nasal endoscopy were recruited in this randomized, placebo-controlled trial and randomly divided into two groups. The study group was treated with montelukast 5 mg daily for 12 weeks while the control group received matching placebo for the same period of time. A questionnaire was completed by each child's parent/guardian to assess the severity of sleep discomfort, snoring, and mouth breathing before and after the intervention.
Results:
Adenoid size decreased in 76% of the study group compared with 3% of the placebo group after 12 weeks. A statically significant improvement was observed in the study group compared with the placebo group in terms of sleep discomfort, snoring, and mouth breathing. The symptoms average total score dropped from 7.7 to 3.3 in the study group, while in the placebo group the total score changed from 7.4 to 6.7.
Conclusion:
Montelukast chewable tablets achieved a significant reduction in adenoid size and improved the related clinical symptoms of AH and can therefore be considered an effective alternative to surgical treatment in children with adenoid hypertrophy.
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