Pediatric Adenoidal Hypertrophy and Nasal Airway Obstruction: Reduction With Aqueous Nasal Beclomethasone
1 Department of Allergy and Immunology, 56th Medical Group, MacDill Air Force Base, FL 33621
2 Allergy-Immunology Department, Wilford Hall Medical Center, Lackland Air Force Base, Lackland, TX
Objective. Pediatric adenoidal obstruction of the nasal airway is associated with significant morbidity and is a frequent indication for surgery. Because efficacious medical alternatives to adenoidectomy are lacking, we assessed the potency of standard-dose topical nasal beclomethasone in reduction of adenoidal obstruction of the nasal airway.
Methods. Seventeen children, 5 to 11 years of age, exhibiting chronic obstructive nasal symptoms and a group mean (±SE) adenoid/choana ratio of 91 ± 1% on rhinoscopic examination, completed an 8-week, double-blind, placebo-controlled crossover study of standard- dose aqueous nasal beclomethasone (total 336 µg/day) in the treatment of adenoidal hypertrophy. In a 16-week, open-label, follow-on study, subjects received beclomethasone 1 spray in each nostril twice daily (168 µg/day).
Results. Over the initial 4 weeks, improvements in the mean adenoidal obstruction of the choanae were significantly greater in the group receiving beclomethasone than in the group receiving placebo (right, -14.0% vs. + 0.4%, P = .0002) (left, -15.0% vs. -2.0%, P = .0006). In the subsequent crossover 4 weeks, a significant beclomethasone carryover effect resulted in further adenoid size reduction in both treatment groups. All patients demonstrated a decrease in adenoid size with beclomethasone treatment, compared with a mixed response to placebo. Over the full 8-week crossover study, the mean (±SE) obstructive symptom score after beclomethasone treatment (20.5 ± 3.0) was significantly improved compared to patients' initial (43.1 ± 2.9) and placebo scores (31.1 ± 4.2, P 
.05), despite the active drug carryover effect into the placebo treatment period. Significant improvements in adenoidal obstruction and symptom scores over the 8-week crossover study were enhanced in the subsequent 16-week open-label period (P = .0001). By 24 weeks, an 82% reduction in group mean nasal obstruction symptom score accompanied a 29% mean reduction in adenoid/choana ratio. No clinical or demographic characteristic predicted a patient's degree of response to treatment.
Conclusions. Properly administered aqueous nasal beclomethasone in standard doses can significantly reduce adenoidal hypertrophy and nasal airway obstructive symptoms in children.
Submitted on June 29, 1994Accepted on July 7, 1994
This article has been cited by other articles:
 |
|
 |
|
  A. G. Kaditis, M. G. Ioannou, K. Chaidas, E. I. Alexopoulos, M. Apostolidou, T. Apostolidis, G. Koukoulis, and K. Gourgoulianis Cysteinyl Leukotriene Receptors Are Expressed by Tonsillar T Cells of Children With Obstructive Sleep Apnea Chest, August 1, 2008; 134(2): 324 - 331. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Kheirandish-Gozal and D. Gozal Intranasal Budesonide Treatment for Children With Mild Obstructive Sleep Apnea Syndrome Pediatrics, July 1, 2008; 122(1): e149 - e155. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Berlucchi, D. Salsi, L. Valetti, G. Parrinello, and P. Nicolai 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, June 1, 2007; 119(6): e1392 - e1397. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Arens Is It Time to Consider a New Treatment for Children with Sleep-disordered Breathing? Am. J. Respir. Crit. Care Med., August 1, 2005; 172(3): 264 - 265. [Full Text] [PDF]
|
|
|
|
 |
|
 G M Nixon and R T Brouillette Sleep {middle dot} 8: Paediatric obstructive sleep apnoea Thorax, June 1, 2005; 60(6): 511 - 516. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Urschitz, A. Guenther, S. Eitner, P. M. Urschitz-Duprat, M. Schlaud, O. S. Ipsiroglu, and C. F. Poets Risk Factors and Natural History of Habitual Snoring Chest, September 1, 2004; 126(3): 790 - 800. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Criscuoli, S. D'Amora, G. Ripa, G. Cinquegrana, N. Mansi, N. Impagliazzo, and A. Pisacane Frequency of Surgery Among Children Who Have Adenotonsillar Hypertrophy and Improve After Treatment With Nasal Beclomethasone Pediatrics, March 1, 2003; 111(3): e236 - 238. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 NASAL BECLOMETHASONE RELIEVES ADENOIDAL NASAL OBSTRUCTION Journal Watch (General), April 4, 1995; 1995(404): 8 - 8. [Full Text]
|
|
