The Effect of Mometasone Furoate Nasal Spray on  Adenoid Hypertrophy and Its Related Obstructive  Sleep Apnea in Pediatric Age Group

Dr.Ayaz Rehman; Dr.Riyaz A. Malla; Dr.Sajad Hamid; Dr.Mushtaq Sangoo

Volume : III, Issue : X, October - 2013

The Effect of Mometasone Furoate Nasal Spray on Adenoid Hypertrophy and Its Related Obstructive Sleep Apnea in Pediatric Age Group

Dr. Ayaz Rehman, Dr. Riyaz A. Malla, Dr. Sajad Hamid, Dr. Mushtaq Sangoo

Abstract :

The treatment for the majority of children with uncomplicated AH is by adenoidectomy that is curative nevertheless,significant risks and problems are associated with this operation . In such instances surgical procedure could be replaced by non surgical methods.We evaluated the utility of mometasone furoate aqueous nasal spray in children with adenoidal hypertrophy. Methods:In the first stage, after a primary clinical evaluation and nasal endoscopy (time 0), children were assigned randomly to receive a single intranasal administration in each nostril of either MF aqueous nasal spray two puffs daily (group A) or a placebo saline solution nasal spray (group B) for 8 wks. At the end of the first 8wks , both groups were reassessed, to evaluate the efficacy of treatment. Patients in group A showed improvements in clinical findings were considered responders. In the second stage, responders underwent “maintenance therapy” for 6 months and were divided randomly into 3 subgroups; (1) patients in group A1 received intranasal MF treatment on alternate days for the first 2 weeks per month.(2) group A2 continued daily topical steroid treatment for the first 2 weeks per month (3) group A3 received intranasal MF treatment on every alternate days. Chronic nasal obstructive symptoms were evaluated using a clinical score ranging from 0 to 3 (0 =absent; 1 = occasional; 2 = frequent; 3 = daytime and nightime symptoms).Thus, a score was assigned to each nasal symptom in relation to their severity. All scores were summed obtaining an overall symptom score for each patient before and after maintenance therapy . AH size was assessed by means of nasal endoscopy. Results: The mean overall symptom scores were 12 for group A and 10 for group B. The use of MF (group A) was associated with significant reduction in adenoid size i.e (76.6 to 39.7%) and the mean overall symptom scores i.e(12 to3). On the contrary, in group B no significant reduction in adenoid size i.e(68.6 to 65.82%) and the mean overall symptom scores i.e (10 to 8). In the second stage, 16 of 60 patients in group A1 received intranasal MF treatment on alternate days for the first 2 weeks per month, 19 of 60 patients in group A2 continued daily topical steroid treatment for the first 2 weeks per month while as 25 of 60 patients in group A1 received intranasal MF treatment on alternate days for 6 month. The mean overall symptoms scores and choanal obstruction showed insignificant difference among these groups. Conclusions: This study concludes that mometasone furoate aqueous nasal spray treatment is a good therapeutic option for adenoidal hypertrophy