Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-23T09:44:58.110Z Has data issue: false hasContentIssue false

Use of intranasal corticosteroids in adenotonsillar hypertrophy

Published online by Cambridge University Press:  27 February 2017

E U Sakarya
Affiliation:
ENT Clinics, Konya Training and Research Hospital, Turkey
N Bayar Muluk*
Affiliation:
Department of Otorhinolaryngology, Medical Faculty, Kirikkale University, Kirikkale, Turkey
E G Sakalar
Affiliation:
ENT Clinics, Yunus Emre State Hospital, Eskisehir, Turkey
M Senturk
Affiliation:
ENT Clinics, Konya Training and Research Hospital, Turkey
M Aricigil
Affiliation:
ENT Department, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
S A Bafaqeeh
Affiliation:
ENT Department, King Saud University, Riyad, Saudi Arabia
C Cingi
Affiliation:
Department of Otorhinolaryngology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
*
Address for correspondence: Dr Nuray Bayar Muluk, Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 blok, No: 6-3/43, 06610 Çankaya, Ankara, Turkey Fax: +90 312 4964073 E-mail: [email protected]

Abstract

Objectives:

This review examined the efficacy of intranasal corticosteroids for improving adenotonsillar hypertrophy.

Method:

The related literature was searched using PubMed and Proquest Central databases.

Results:

Adenotonsillar hypertrophy causes mouth breathing, nasal congestion, hyponasal speech, snoring, obstructive sleep apnoea, chronic sinusitis and recurrent otitis media. Adenoidal hypertrophy results in the obstruction of nasal passages and Eustachian tubes, and blocks the clearance of nasal mucus. Adenotonsillar hypertrophy and obstructive sleep apnoea are associated with increased expression of various mediators of inflammatory responses in the tonsils, and respond to anti-inflammatory agents such as corticosteroids. Topical nasal steroids most likely affect the anatomical component by decreasing inspiratory upper airway resistance at the nasal, adenoidal or tonsillar levels. Corticosteroids, by their lympholytic or anti-inflammatory effects, might reduce adenotonsillar hypertrophy. Intranasal corticosteroids reduce cellular proliferation and the production of pro-inflammatory cytokines in a tonsil and adenoid mixed-cell culture system.

Conclusion:

Intranasal corticosteroids have been used in adenoidal hypertrophy and adenotonsillar hypertrophy patients, decreasing rates of surgery for adenotonsillar hypertrophy.

Type
Review Articles
Copyright
Copyright © JLO (1984) Limited 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Scadding, G. Non-surgical treatment of adenoidal hypertrophy: the role of treating IgE-mediated inflammation. Pediatr Allergy Immunol 2010;21:1095–106Google Scholar
2 Kurnatowski, P, Putyński, L, Łapienis, M, Kowalska, B. Physical and emotional disturbances in children with adenotonsillar hypertrophy. J Laryngol Otol 2008;122:931–5Google Scholar
3 Ray, RM, Bower, CM. Pediatric obstructive sleep apnea: the year in review. Curr Opin Otolaryngol Head Neck Surg 2005;13:360–5Google Scholar
4 Friedman, BC, Hendeles-Amitai, A, Kozminsky, E, Leiberman, A, Friger, M, Tarasiuk, A et al. Adenotonsillectomy improves neurocognitive function in children with obstructive sleep apnea syndrome. Sleep 2003;26:9991005 Google Scholar
5 Goldstein, NA, Fatima, M, Campbell, TF, Rosenfeld, RM. Child behavior and quality of life before and after tonsillectomy and adenoidectomy. Arch Otolaryngol Head Neck Surg 2002;128:770–5Google Scholar
6 Kim, J, Bhattacharjee, R, Dayyat, E, Snow, AB, Kheirandish-Gozal, L, Goldman, JL et al. Increased cellular proliferation and inflammatory cytokines in tonsils derived from children with obstructive sleep apnea. Pediatr Res 2009;66:423–8Google Scholar
7 Kheirandish-Gozal, L, Serpero, LD, Dayyat, E, Kim, J, Goldman, JL, Snow, A et al. Corticosteroids suppress in vitro tonsillar proliferation in children with obstructive sleep apnoea. Eur Respir J 2009;33:1077–84Google Scholar
8 Goldbart, AD, Veling, MC, Goldman, JL, Li, RC, Brittian, KR, Gozal, D. Glucocorticoid receptor subunit expression in adenotonsillar tissue of children with obstructive sleep apnea. Pediatr Res 2005;57:232–6Google Scholar
9 Demain, JG, Goetz, DW. Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone. Pediatrics 1995;95:355–64Google Scholar
10 Goldbart, AD, Krishna, J, Li, RC, Serpero, LD, Gozal, D. Inflammatory mediators in exhaled breath condensate of children with obstructive sleep apnea syndrome. Chest 2006;130:143–8Google Scholar
11 Goldbart, AD, Tal, A. Inflammation and sleep disordered breathing in children: a state-of-the-art review. Pediatr Pulmonol 2008;43:1151–60Google Scholar
12 Brouillette, RT, Manoukian, JJ, Ducharme, FM, Oudjhane, K, Earle, LG, Ladan, S et al. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 2001;138:838–44Google Scholar
13 Al-Ghamdi, SA, Manoukian, JJ, Morielli, A, Oudjhane, K, Ducharme, FM, Brouillette, RT. Do systemic corticosteroids effectively treat obstructive sleep apnea secondary to adenotonsillar hypertrophy? Laryngoscope 1997;107:1382–7Google Scholar
14 Alexopoulos, EI, Kaditis, AG, Kalampouka, E, Kostadima, E, Angelopoulos, NV, Mikraki, V et al. Nasal corticosteroids for children with snoring. Pediatr Pulmonol 2004;38:161–7Google Scholar
15 Goldbart, AD, Goldman, JL, Veling, MC, Gozal, D. Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med 2005;172:364–70Google Scholar
16 Bhargava, R, Chakravarti, A. A double-blind randomized placebo-controlled trial of topical intranasal mometasone furoate nasal spray in children of adenoidal hypertrophy with otitis media with effusion. Am J Otolaryngol 2014;35:766–70Google Scholar
17 Berlucchi, M, Sessa, M. Can adenoidal hypertrophy be treated with intranasal steroids? Rev Recent Clin Trials 2010;5:123–7Google Scholar
18 Beasley, P. Anatomy of the pharynx and oesophagus. In: Kerr, AG, Gleeson, M, eds. Scott-Brown's Otorhinolaryngology, 6th edn. Oxford: Butterworth-Heinemann Publications, 1997;140 Google Scholar
19 Kenna, MA, Amin, A. Anatomy and physiology of the oral cavity. In: Snow, JB, Wackym, PA, eds. Ballenger's Otorhinolaryngology Head and Neck Surgery, 17th edn. Shelton, CT: BC Decker, 2009;769–74Google Scholar
20 Standring, S. Pharynx. In: Standring, S, ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice, 39th edn. Philadelphia: Elsevier/Churchill Livingstone, 2005;619–31Google Scholar
21 Medscape. Tonsil and Adenoid Anatomy. In: http://emedicine.medscape.com/article/1899367-overview#a3 [15 March 2016]Google Scholar
22 Wiatrak, BJ, Woolley, AL. Pharyngitis and adenotonsillar disease. In: Cummings, CW, Fredrickson, JM, Harker, LA, Crause, CJ, Schuller, DE, Richardson, MA, eds. Otolaryngology Head and Neck Surgery, 3rd edn. London: Mosby, 1998;188215 Google Scholar
23 Çelebi, Ş, Çelik, Ö, Karaca, ÇT, Ulusoy, S. Multiparametric comparison of thermal welding versus cold knife tonsillectomy with tonsil size. J Med Updates 2013;3:1318 Google Scholar
24 Hellings, PW, Fokkens, WJ. Allergic rhinitis and its impact on otorhinolaryngology. Allergy 2006;61:656–64Google Scholar
25 Haapaniemi, JJ. Adenoids in school-aged children. J Laryngol Otol 1995;109:196202 Google Scholar
26 Huang, SW, Giannoni, C. The risk of adenoid hypertrophy in children with allergic rhinitis. Ann Allergy Asthma Immunol 2001;87:350–5Google Scholar
27 Berlucchi, M, Salsi, D, Valetti, L, Parrinello, G, Nicolai, P. The role of mometasone furoate aqueous nasal spray in the treatment of adenoidal hypertrophy in the pediatric age group: preliminary results of a prospective, randomized study. Pediatrics 2007;119:e13927 Google Scholar
28 Kveton, JF, Pillsbury, HC 3rd, Sasaki, CT. Nasal obstruction: adenoiditis vs adenoid hypertrophy. Arch Otolaryngol 1982;108:315–18Google Scholar
29 Papatziamos, G, Van Der Ploeg, I, Hemlin, C, Patwardhan, A, Scheynius, A. Increased occurrence of IgE+ and FcεRI+ cells in adenoids from atopic children. Allergy 1999;54:916–25Google Scholar
30 Fokkens, WJ, Vinke, JG, De Jong, SS, Bogaert, DP, Kleinjan, A, Eichhorn, E. Differences in cellular infiltrates in the adenoid of allergic children compared with age- and gender-matched controls. Clin Exp Allergy 1998;28:187–95Google Scholar
31 Nguyen, LH, Manoukian, JJ, Sobol, SE, Tewfik, TL, Mazer, BD, Schloss, MD et al. Similar allergic inflammation in the middle ear and the upper airway: evidence linking otitis media with effusion to the united airways concept. J Allergy Clin Immunol 2004;114:1110–15Google Scholar
32 Goldbart, AD, Veling, MC, Goldman, JL, Li, RC, Brittian, KR, Gozal, D. Glucocorticoid receptor subunit expression in adenotonsillar tissue of children with obstructive sleep apnea. Pediatr Res 2005;57:232–6Google Scholar
33 Mabry, RL. Corticosteroids in the management of upper respiratory allergy: the emerging role of steroid nasal sprays. Otolaryngol Head Neck Surg 1992;107:855–60Google Scholar
34 Fraunfelder, FT, Meyer, SM. Posterior subcapsular cataracts associated with nasal or inhalation corticosteroids. Am J Ophthalmol 1990;109:489–90Google Scholar
35 Oztürk, F, Yücetürk, AV, Kurt, E, Unlü, HH, Ilker, SS. Evaluation of intraocular pressure and cataract formation following the long-term use of nasal corticosteroids. Ear Nose Throat J 1998;77:846–8, 850–1Google Scholar
36 Check, WA, Kaliner, MA. Pharmacology and pharmacokinetics of topical corticosteroid derivatives used for asthma therapy. Am Rev Respir Dis 1990;141:S4451 Google Scholar
37 Ryrfeldt, A, Andersson, P, Edsbäcker, S, Tönnesson, M, Davies, D, Pauwels, R. Pharmacokinetics and metabolism of budesonide, a selective glucocorticoid. Eur J Respir Dis 1982;122:8695 Google Scholar
38 Wallace, DV, Dykewicz, MS, Bernstein, DI, Blessing-Moore, J, Cox, L, Khan, DA et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol 2008;122(2 suppl):S184 Google Scholar
39 Zitt, M, Kosoglou, T, Hubbell, J. Mometasone furoate nasal spray: a review of safety and systemic effects. Drug Saf 2007;30:317–26Google Scholar
40 Medscape. Nasal Polyps Treatment & Management. In: http://emedicine.medscape.com/article/994274-treatment [15 March 2016]Google Scholar
41 Ferguson, AC, Spier, S, Manjra, A, Versteegh, FG, Mark, S, Zhang, P. Efficacy and safety of high-dose inhaled steroids in children with asthma: a comparison of fluticasone propionate with budesonide. J Pediatr 1999;134:422–7Google Scholar
42 Lipworth, BJ. Systemic adverse effects of inhaled corticosteroid therapy: a systematic review and meta-analysis. Arch Intern Med 1999;159:941–55Google Scholar
43 Barnes, PJ, Pedersen, S. Efficacy and safety of inhaled corticosteroids in asthma. Report of a workshop held in Eze, France, October 1992. Am Rev Respir Dis 1993;148:S126 Google Scholar
44 Lane, JC, Dworkin-Valenti, J, Chiodo, L, Haupert, M. Postoperative tonsillectomy bleeding complications in children: a comparison of three surgical techniques. Int J Pediatr Otorhinolaryngol 2016;88:184–8Google Scholar
45 Jones, DT, Kenna, MA, Guidi, J, Huang, L, Johnston, PR, Licameli, GR. Comparison of postoperative pain in pediatric patients undergoing coblation tonsillectomy versus cautery tonsillectomy. Otolaryngol Head Neck Surg 2011;144:972–7Google Scholar
46 Gallagher, TQ, Wilcox, L, McGuire, E, Derkay, CS. Analyzing factors associated with major complications after adenotonsillectomy in 4776 patients: comparing three tonsillectomy techniques. Otolaryngol Head Neck Surg 2010;142:886–92Google Scholar
47 Divi, V, Benninger, M. Postoperative tonsillectomy bleed: coblation versus noncoblation. Laryngoscope 2005;115:31–3Google Scholar
48 Setabutr, D, Adil, EA, Adil, TK, Carr, MM. Emerging trends in tonsillectomy. Otolaryngol Head Neck Surg 2011;145:223–9Google Scholar
49 Rakover, Y, Almog, R, Rosen, G. The risk of postoperative haemorrhage in tonsillectomy as an outpatient procedure in children. Int J Pediatr Otorhinolaryngol 1997;41:2936 Google Scholar
50 Randall, DA, Hoffer, ME. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 1998;118:61–8Google Scholar
51 Medscape. Tonsillectomy Treatment & Management. In: http://reference.medscape.com/article/872119-treatment#d14 [19 October 2016]Google Scholar
52 Leinbach, RF, Markwell, SJ, Colliver, JA, Lin, SY. Hot versus cold tonsillectomy: a systematic review of the literature. Otolaryngol Head Neck Surg 2003;129:360–4Google Scholar
53 Tonsillectomy (with or without adenoidectomy) in children: postoperative care and complications. In: http://www.uptodate.com/contents/tonsillectomy-with-or-without-adenoidectomy-in-children-postoperative-care-and-complications [9 June 2016]Google Scholar
54 Royal Australasian College of Physicians and Australian Society of Otolaryngology Head and Neck Surgery. A Joint Position Paper of the Paediatrics & Child Health Division of The Royal Australasian College of Physicians and The Australian Society of Otolaryngology, Head and Neck Surgery. Sydney: Royal Australasian College of Physicians and Australian Society of Otolaryngology Head and Neck Surgery, 2008 Google Scholar
55 Royal College of Surgeons of England. National Prospective Tonsillectomy Audit. Final Report of an Audit carried out in England and Northern Ireland between July 2003 and September 2004. London: Royal College of Surgeons of England, 2005 Google Scholar
56 Edmonson, MB, Eickhoff, JC, Zhang, C. A population-based study of acute care revisits following tonsillectomy. J Pediatr 2015;166:607–12Google Scholar
57 Shay, S, Shapiro, NL, Bhattacharyya, N. Revisit rates and diagnoses following pediatric tonsillectomy in a large multistate population. Laryngoscope 2015;125:457–61Google Scholar
58 Curtis, JL, Harvey, DB, Willie, S, Narasimhan, E, Andrews, S, Henrichsen, J et al. Causes and costs for ED visits after pediatric adenotonsillectomy. Otolaryngol Head Neck Surg 2015;152:691–6Google Scholar
59 Jonas, NE, Sayed, R, Prescott, CA. Prospective, randomized, single-blind, controlled study to compare two methods of performing adenoidectomy. Int J Pediatr Otorhinolaryngol 2007;71:1555–62Google Scholar
60 Yumoto, E, Kozawa, T, Yanagihara, N. Influence of tonsillar hypertrophy to physical growth and diseases of the nose and ear in school-age children [in Japanese]. Nihon Jibiinkoka Gakkai Kaiho 1991;94:534–40Google Scholar
61 Mansfield, LE, Diaz, G, Posey, CR, Flores-Neder, J. Sleep disordered breathing and daytime quality of life in children with allergic rhinitis during treatment with intranasal budesonide. Ann Allergy Asthma Immunol 2004;92:240–4Google Scholar
62 Modrzynski, M, Zawisza, E. An analysis of the incidence of adenoid hypertrophy in allergic children. Int J Pediatr Otorhinolaryngol 2007;71:713–19Google Scholar
63 Modrzyński, M, Zawisza, E, Mazurek, H. The influence of medical treatment of the perennial allergic rhinitis on the adenoid size in children [in Polish]. Otolaryngol Pol 2006;60:543–50Google Scholar
64 Zhang, L, Mendoza-Sassi, RA, César, JA, Chadha, NK. Intranasal corticosteroids for nasal airway obstruction in children with moderate to severe adenoidal hypertrophy. Cochrane Database Syst Rev 2008;(16):CD006286Google Scholar
65 Ciprandi, G, Varricchio, A, Capasso, M, Varricchio, AM, De, LA, Ascione, E et al. Intranasal flunisolide treatment in children with adenoidal hypertrophy. Int J Immunopathol Pharmacol 2007;20:833–6Google Scholar
66 Varricchio, A, Tortoriello, G, Capasso, M, De, LA, Marchisio, P, Varricchio, AM et al. Prevention of surgery in children with adenoidal hypertrophy treated with intranasal flunisolide: a 12-month follow-up. J Biol Regul Homeost Agents 2009;23:95101 Google Scholar
67 Jazi, SM, Barati, B, Kheradmand, A. Treatment of adenotonsillar hypertrophy: a prospective randomized trial comparing azithromycin vs. fluticasone. J Res Med Sci 2011;16:1590–7Google Scholar
68 Brouillette, RT, Manoukian, JJ, Ducharme, FM, Oudjhane, K, Earle, LG, Ladan, S et al. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 2001;138:838–44Google Scholar
69 Kheirandish-Gozal, L, Gozal, D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics 2008;122:e14955 Google Scholar
70 Criscuoli, G, D'Amora, S, Ripa, G, Cinquegrana, G, Mansi, N, Impagliazzo, N et al. Frequency of surgery among children who have adenotonsillar hypertrophy and improve after treatment with nasal beclomethasone. Pediatrics 2003;111:e2368 Google Scholar
71 Kuyucu, S, Kuyuucu, N, Unal, S, Apaydın, D. Nonsurgical treatment of adenoidal hypertrophy with cefuroxime axetil and intranasal mometasone furoate combination. J Pediatr Inf 2007;1:612 Google Scholar
72 Mygind, N, Nielsen, LP, Hoffmann, HJ, Shukla, A, Blumberga, G, Dahl, R et al. Mode of action of intranasal corticosteroids. J Allergy Immunol 2001;108:S1625 Google Scholar
73 Brodsky, L, Moore, L, Stanievich, JF, Ogra, PL. The immunology of tonsils in children: the effect of bacterial load on the presence of B- and T-cell subsets. Laryngoscope 1988;98:93–8Google Scholar
74 Stanbury, RM, Graham, EM. Systemic corticosteroid therapy--side effects and their management. Br J Ophthalmol 1998;82:704–8Google Scholar
75 Allen, DB. Systemic effects of intranasal steroids: an endocrinologist's perspective. J Allergy Clin Immunol 2000;106:S17990 Google Scholar