Montelukast in Adenoid Hypertrophy: Its Effect on Size and Symptoms

Document Type : Original

Authors

1 Department of Otorhinolaryngology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Sinus and Surgical Endoscopic Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

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.

Keywords

Main Subjects

References

1. Shirley WP, Wooley AL Pharyngitis and Adenotonsillar Disease In: Cummings et al. Otolaryngology: Head and Neck Surgery. 5th ed. Philadelphia PA; p2782.
2. Saedi B, Sadeghi M, Mojtahed M, Mahboubi H. Diagnostic efficacy of different methods in the assessment of adenoid hypertrophy. Am J Otolaryngol 2011; 32(2):147–51.
3. Ikincioğullari A, Doğu F, ikincioğullari A, Eğin Y, Babacan E. Is immune system influenced by adenotonsillectomy in children? Int J Pediatr Otorhinolaryngol 2002; 66(3):251–7.
4. Dayyat E, Serpero LD, Kheirandish-Gozal L, Goldman JL, Snow A, Bhattacharjee R, et al. Leukotriene pathways and in vitro adenotonotonsillar cell proliferation in children with obstructive sleep apnea. Chest 2009; 135(5): 1142–9.
5. Berlucchi M, Salsi D, Valetti L, Parrinello G, Nicolai P. The role of montelukast in the treatment of adenoidal hypertrophy in the pediatric age group: preliminary results of a prospective, randomized study. Pediatrics 2007;119(6):e1392–7.
6. Mizutani N, Nabe T, Imai A, Sakurai H, Takenaka H, Kohno S. Markedly increased nasal blockage by intranasal leukotriene D4 in an experimental allergic rhinitis model: contribution of dilated mucosal blood vessels. Jpn J Pharmacol 2001;86(2):170–82.
7. Cohen D, Konak S. The evaluation of radiographs of the nasopharynx. Clin Otolaryngol Allied Sci 1985; 10(2):73–8.
8. Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. AJR Am J Roentgenol 1979;133(3):401–4.
9. Parikh SR, Coronel M, Lee JJ, Brown SM. Validation of a new grading system for endoscopic examination of adenoid hypertrophy. Otolaryngol Head Neck Surg 2006;135(5):684–7.
10. Caylakli F, Hizal E, Yilmaz I, Yilmazer C. Correlation between adenoid-nasopharynx ratio and endoscopic examination of adenoidhypertrophy: a blind, prospective clinical study. Int J Pediatr Otorhinolaryngol 2009; 73(11): 1532–5.
11. Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep-isordered breathing in children. Am J Respir Crit Care Med 2005; 172(3):364–70.
12. Kuhle S, Urschitz MS. Anti-inflammatory medications for obstructive sleep apnea in children. Cochrane Database Syst Rev. 2011 19; (1): CD007074.
13. Goldbart AD, Greenberg-Dotan S, Tal A. Montelukast for children with obstructive sleep apnea: a double-blind, placebo-controlled study. Pediatrics 2012; 130(3):e575–80.
Iranian Journal of Otorhinolaryngology
Volume 27, Issue 6 - Serial Number 6
November and December 2015
Pages 453-458

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