Skip to main content
SpringerLink
Log in

Maximal medical treatment of adenoid hypertrophy: a prospective study of preschool children

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 01 March 2024

Abstract

Purpose

This study aimed to examine the effectiveness of the combined maximal medical treatment for adenoid hypertrophy in preschool children.

Methods

Sixty-four children underwent one-year combined therapy with intranasal mometasone furoate, oral desloratadine, nasal saline irrigation, and bacteriotherapy. Additionally, decongestion drops were applied during scheduled breaks.

Results

Of the 64 treated children, 72% showed clinical improvement in adenoid symptoms while 28% did not improve and underwent surgery. These groups differed significantly in terms of the overall reduction in ailments after treatment (p < 0.001), infection rate (p < 0.001), catarrh severity (p < 0.001) and nasal patency (p < 0.001). Endoscopic examination confirmed that responders experienced, on average, a decrease of 8.4% in the adenoid/choana ratio and an improvement in mucosal coverage of the adenoid. These effects were not observed in the group of children whose parents opted for surgery after nine months of conservative treatment.

Conclusions

The proposed new schema of long-term maximal medical treatment with the use of combined intermittent treatment of intranasal mometasone furoate and decongestion drops, oral desloratadine, nasal saline irrigation, and bacteriotherapy can be attempted in patients with adenoid hypertrophy symptoms, and responders may avoid the need for surgery. The applied treatment breaks resulted in a low number of therapeutic side effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of data and materials

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to the need to protect personal data.

References

  1. Niedzielski A, Chmielik LP, Mielnik-Niedzielska G et al (2023) Adenoid hypertrophy in children: a narrative review of pathogenesis and clinical relevance. BMJ Paediatr Open 7:e001710

    Article  PubMed  PubMed Central  Google Scholar 

  2. Zwierz A, Domagalski K, Masna K, Burduk P (2022) Effectiveness of Evaluation of Adenoid Hypertrophy in Children by Flexible Nasopharyngoscopy Examination (FNE), Proposed Schema of Frequency of Examination: Cohort Study. Diagnostics (Basel) 12(7):1734

    Article  PubMed  Google Scholar 

  3. Tomkinson A, Harrison W, Owens D, Fishpool S, Temple M (2012) Postoperative hemorrhage following adenoidectomy. Laryngoscope 122(6):1246–1253

  4. Isokääntä S, Koivula K, Honkalampi K, Kokki H (2019) Resilience in children and their parents enduring pediatric medical traumatic stress. Paediatr Anaesth 29(3):218–225

    Article  PubMed  Google Scholar 

  5. Sullivan V, Sullivan DH, Weatherspoon D (2021) Parental and Child Anxiety Perioperatively: Relationship, Repercussions, and Recommendations. J Perianesth Nurs 36(3):305–309

    Article  PubMed  Google Scholar 

  6. Meyer HW (1870) On Adenoid Vegetations in the Naso-Pharyngeal Cavity: Their Pathology, Diagnosis and Treatment. Medico-Chirurgical Transactions, London 53:191–217

    CAS  Google Scholar 

  7. Zwierz A, Masna K, Domagalski K, Burduk P (2023) 150th Anniversary of global adenoid investigations: unanswered questions and unsolved problems. Front Pediatr 11:2023

    Article  Google Scholar 

  8. Jazi SM, Barati B, Kheradmand A. Treatment of adenotonsillar hypertrophy: a prospective randomized trial comparing azithromycin vs. "uticasone. J Res Med Sci.(2011) 16(12):1590–7.

  9. Sclafani AP, Ginsburg J, Shah MK, Dolitsky JN (1998) Treatment of symptomatic chronic adenotonsillar hypertrophy with amoxicillin/clavulanate potassium: short- and long-term results. Pediatrics 101(4 Pt 1):675–681

    Article  CAS  PubMed  Google Scholar 

  10. Chung HR, Miller JE, Suh JD (2023) Safety of Antibiotic Irrigations for Acute Exacerbations of Chronic Rhinosinusitis in Patients with Identical Drug Allergies or Adverse Reactions: A Pilot Study. Ear Nose Throat J 31:1455613231189057

    Article  Google Scholar 

  11. Ciprandi G, La Mantia I, Damiani V, Passali D (2020) Local bacteriotherapy - a promising preventive tool in recurrent respiratory infections. Expert Rev Clin Immunol 16(11):1047–1052

    Article  CAS  PubMed  Google Scholar 

  12. La Mantia I, Varricchio A, Di Girolamo S, Minni A, Passali GC, Ciprandi G (2019) The role of bacteriotherapy in the prevention of adenoidectomy. Eur Rev Med Pharmacol Sci 23(1 Suppl):44–47

    PubMed  Google Scholar 

  13. Dziekiewicz M, Cudejko R, Banasiuk M, Dembiński Ł, Skarżyński H, Radzikowski A, Banaszkiewicz A (2020) Frequency of gastroesophageal reflux disease in children with adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 138:110304

    Article  PubMed  Google Scholar 

  14. Iqbal FR, Goh BS, Mazita A (2012) The role of proton pump inhibitors in adenoid hypertrophy in children. Otolaryngol Head Neck Surg 147(2):329–334

    Article  PubMed  Google Scholar 

  15. 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(6):102723.

  16. Aldea Perona A, García-Sáiz M, Sanz ÁE (2016) Psychiatric Disorders and Montelukast in Children: A Disproportionality Analysis of the VigiBase(®). Drug Saf 39(1):69–78

    Article  CAS  PubMed  Google Scholar 

  17. Wallerstedt SM, Brunlöf G, Sundström A, Eriksson AL (2009) Montelukast and psychiatric disorders in children. Pharmacoepidemiol Drug Saf 18(9):858–864

    Article  CAS  PubMed  Google Scholar 

  18. Wang P, Kong W, Shan Y (2020) The efficacy and safety of Chinese herbal compound or combined with western medicine for pediatric adenoidal hypertrophy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 99(36):e22023

    Article  PubMed  Google Scholar 

  19. Goldbart AD, Veling MC, Goldman JL, Li RC, Brittian KR, Gozal D (2005) Glucocorticoid Receptor Subunit Expression in Adenotonsillar Tissue of Children with Obstructive Sleep Apnea. Pediatr Res 57:232–236

    Article  CAS  PubMed  Google Scholar 

  20. Ciprandi G, Varricchio A, Capasso M, Varricchio AM, De Lucia A, Ascione E, Avvisati F, Capristo C, Marseglia GL, Barillari U. Intranasal flunisolide treatment in children with adenoidal hypertrophy. Int J Immunopathol Pharmacol. 2007 Oct-Dec;20(4):833–6.

  21. Cengel S, Akyol MU (2006) The role of topical nasal steroids in the treatment of children with otitis media with effusion and/or adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 70(4):639–645

    Article  CAS  PubMed  Google Scholar 

  22. Bhargava R, Chakravarti A (2014) Role of mometasone furoate aqueous nasal spray for management of adenoidal hypertrophy in children. J Laryngol Otol 128(12):1060–1066

    Article  CAS  PubMed  Google Scholar 

  23. Masna K, Zwierz A, Domagalski K, Burduk P (2021) The Impact of the Thermal Seasons on Adenoid Size, Its Mucus Coverage and Otitis Media with Effusion: A Cohort Study. J Clin Med 10(23):5603

    Article  PubMed  PubMed Central  Google Scholar 

  24. Zwierz A, Masna K, Domagalski K, Burduk P (2022) The Long-Term Effects of 12-Week Intranasal Steroid Therapy on Adenoid Size, Its Mucus Coverage and Otitis Media with Effusion: A Cohort Study in Preschool Children. J Clin Med 11:507

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Criscuoli G, D’Amora S, Ripa G et al (2003) Frequency of surgery among children who have adenotonsillar hypertrophy and improve after treatment with nasal beclomethasone. Pediatrics 111:236–238

    Article  Google Scholar 

  26. Berlucchi M, Valetti L, Parrinello G, Nicolai P (2008) Long-term follow-up of children undergoing topical intranasal steroid therapy for adenoidal hypertrophy. Int J Pediatr Otorhinolaryngol 72(8):1171–1175

    Article  PubMed  Google Scholar 

  27. Eren E, Arslanoğlu S, Erdem SB, Nacaroğlu T, Karkıner CŞ, Can D, Önal K (2015) Chicken or the egg: the dilemma of allergic rhinitis versus adenoid hypertrophy. Rhinology 53(2):154–159

    Article  PubMed  Google Scholar 

  28. Bousquet J et al (2008) Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA (2) LEN and AllerGen). Allergy 63(suppl 86):8–160

    Article  PubMed  Google Scholar 

  29. Lofstrand-Tidestrom B, Hultcrantz E (2007) The development of snoring and sleep related breathing distress from 4 to 6 years in a cohort of Swedish children. Int J Pediatr Otorhinolaryngol 71:1025–1033

    Article  PubMed  Google Scholar 

  30. Georgitis JW (1994) Nasal hyperthermia and simple irrigation for perennial rhinitis. Changes in inflammatory mediators Chest 106(5):1487–1492

    CAS  PubMed  Google Scholar 

  31. Marchisio P, Varricchio A, Baggi E, Bianchini S, Capasso ME, Torretta S, Capaccio P, Gasparini C, Patria F, Esposito S, Principi N. Hypertonic saline is more effective than normal saline in seasonal allergic rhinitis in children. Int J Immunopathol Pharmacol. 2012 Jul-Sep;25(3):721–30.

  32. Boleslavská, J.; Koprivová, H.; Komínek, P. Is it important to evaluate the size of adenoid vegetations? Otorinolaryngol Foniatr 2006, 55, 133–138. (In Czech)

  33. Demirhan H, Aksoy F, Ozturan O, Yildirim YS, Veyseller B (2010) Medical treatment of adenoid hypertrophy with “fluticasone propionate nasal drops.” Int J Pediatr Otorhinolaryngol 74(7):773–776

    Article  PubMed  Google Scholar 

  34. Bhat VK, Razi AM, Kumar VB (2017) Steroid Nasal Spray versus Curettage Adenoidectomy in School Children – A Randomized Controlled Trial. J Otolaryngol ENT Res 8(5):00259

    Article  Google Scholar 

  35. Klain A, Indolfi C, Dinardo G, Licari A, Cardinale F, Caffarelli C, Manti S, Ricci G, Pingitore G, Tosca M, Decimo F, Miraglia Del Giudice M. United airway disease . Acta Biomed [Internet]. 2021 Nov. 29 [cited 2023 Jul. 16];92(S7):e2021526

  36. Arslan E, Tulaci KG, Canakci H, Arslan S, Yazici H. Evaluation of the intranasal steroid treatment outcomes in adenoid tissue hypertrophy with or without allergic rhinitis. Am J Otolaryngol. 2021 Jul-Aug;42(4):102983.

  37. Bachert C, van Cauwenberge P (2007) Desloratadine treatment for intermittent and persistent allergic rhinitis: a review. Clin Ther 29(9):1795–1802

    Article  CAS  PubMed  Google Scholar 

  38. Passali D, Spinosi MC, Crisanti A, Bellussi LM (2016) Mometasone furoate nasal spray: a systematic review. Multidiscip Respir Med 2(11):18

    Article  Google Scholar 

  39. Monga R, Sanjeev B, Dimple S, Harjinder S, Dinesh S (2020) Role of mometasone furoate nasal spray versus saline nasal spray in treatment of adenoid hypertrophy: a prospective, randomized study. Int J Otorhinolaryngol Head Neck Surg 6:1841

    Article  Google Scholar 

  40. Griffin G, Flynn CA. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev. 2011;9:CD003423.

  41. Roditi RE, Caradonna DS, Shin JJ (2019) The Proposed Usage of Intranasal Steroids and Antihistamines for Otitis Media with Effusion. Curr Allergy Asthma Rep 19(10):47

    Article  PubMed  Google Scholar 

  42. Collins MP, Church MK, Bakhshi KN, Osborne J (1985) Adenoid histamine and its possible relationship to secretory otitis media. J Laryngol Otol 99:685–691

    Article  CAS  PubMed  Google Scholar 

  43. Ulualp SO, Sahin D, Yilmaz N, Anadol V, Peker O, Gursan O (1999) Increased adenoid mast cells in patients with otitis media with effusion. Int J Pediatr Otorhinolaryngol 49:107–114

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

This research received no external funding.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, University Hospital No 2, Ujejskiego Street 75, 85-168, Bydgoszcz, Poland

    Aleksander Zwierz, Krystyna Masna & Paweł Burduk

  2. Department of Immunology, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, 87-100, Torun, Poland

    Krzysztof Domagalski

Authors
  1. Aleksander Zwierz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Krzysztof Domagalski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Krystyna Masna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paweł Burduk
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, A.Z.; methodology, A.Z., K.D.; software, K.D.; validation, A.Z. and K.D.; formal analysis, A.Z., K.D. investigation, A.Z. resources, A.Z.; data curation, A.Z.; writing—original draft preparation, A.Z.; writing—review and editing, K.M.; visualization, K.M.; supervision, P.B.; project administration, A.Z.; funding acquisition, A.Z. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Aleksander Zwierz.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethic approval and consent to participate.

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of Nicolaus Copernicus University (KB 141/2022).

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zwierz, A., Domagalski, K., Masna, K. et al. Maximal medical treatment of adenoid hypertrophy: a prospective study of preschool children. Eur Arch Otorhinolaryngol 281, 2477–2487 (2024). https://doi.org/10.1007/s00405-024-08459-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-024-08459-6

Keywords

Search

Navigation