Effect of Nasal Budesonide in improve symptoms of adenoid hypertrophy in children

Abstract

Background & Objective:Adenoid Hypertrophy (AH) is a common disease of childhood causing a lot of symptoms as :snoring – chronic nasal discharge , mouth breathing and play an important role (with tonsil hypertrophy )in obstructive sleep apnea(OSA) an addition to the role in Middle ear pathology. Topical budesonide has been a widely used anti-inflammatory agent(corticosteroid) in the treatment of allergic rhinitis, and nasal polyp and maybe used to alleviating symptoms of AH and nasal obstruction. The aim of this study to conduct the effect of nasal budesonide on AH and the related symptoms in children.

Materials & Methods: Randomized control trail for children between 5 – 8 y with adenoid hypertrophy grade 2 and 3.The patients with AH were randomized to receive either a nasal budesonide (study group) or Nasal saline (control group )for 8 weeks and study the effect of treatment on AH .Snoring ,OSA and Otitis media with effusion. Nasopharyngeal X-rays was performed before and after treatment and grading AH according to the Fujioka method. The data was collected about symptoms before and after treatment then analysed and compared to make the conclusions

 Results: The study group consisting of 26 patients  17 males and 9 females was .The control group consisting of 26 patients  15 males and 11 females .In study Group ,the degrees of adenoid hypertrophy before treatment were grade 2 in 13 patients (50%) and grade 3 in 13 patients (50%), and after treatment were grade 1 in 14 patients (54%) . grade 2 in 10 patients (38%)and grade 3 in two patients (8%).In control Group ,the degrees of adenoid hypertrophy before treatment were grade 2 in 16 patients (62%) and grade 3 in 10 patients (38%), and after treatment were grade 1 in 3 patients (12%) . grade 2 in 17 patients (65%)and grade 3 in 6 patients (23%) .A statistically significant difference was present between groups before and after treatment (P<0.0001).Also there was a statistically significant difference between groups before and after treatment in improving grades of snoring (P<0.0001 ) but not in improving OSA ( P =0.692).There was no important complication or side effects after treatment except mild epistaxis in 3 patients in study groups.

Conclusions: The use of intranasal Budesonide for 8 weeks in children with adenoid hypertrophy may be an effective and safe treatment modality in addition to improving snoring and mild OSA, and can be used as a first choice in treatment adenoid hypertrophy before go to surgical treatment.