Demirhan Hasan, Aksoy Fadlullah, Ozturan Orhan, Yildirim Yavuz Selim, Veyseller Bayram
Haseki Education and Research Hospital, Ear Nose Throat (ENT), 1st Otorhinolaryngology Clinic, Istanbul, Turkey.
Int J Pediatr Otorhinolaryngol. 2010 Jul;74(7):773-6. doi: 10.1016/j.ijporl.2010.03.051. Epub 2010 Apr 28.
Adenoid hypertrophy treatment for children is generally planned in accordance with the degree of airway obstruction and related morbidity. If surgical treatment is indicated, the individual risk/benefit analysis of patients should be assessed in terms of anesthetic and postoperative complications. Although there are few alternative treatment options, these may be considered as a nonsurgical approach in less serious cases. Accordingly, studies about intranasal steroid applications under various protocols have been presented.
The prospective, randomized, placebo-controlled study.
Tertiary referral center.
Patients indicated for surgery were randomly divided into two groups. The study group was treated by fluticasone propionate nasal drops (NSD-nasal steroid drops) of 400 microg/day for 8 weeks. The control group was treated by normal saline (NS) in the same way. All the patients were called for follow-up every 4 weeks.
At the end of 8 weeks, statistically significant improvement (p<0.05) was observed in the NSD treated group compared to the NS treated group in terms of nasal airway obstruction, mouth breathing, speech abnormalities, apnea and night cough. At the end of 8 weeks, the average total symptoms score of the NSD treated group dropped from 13.7 to 2.9 while the NS treated group's score changed from 14.8 to 14.6. After 8 weeks of NSD treatment the initial adenoid/choana (A/C) rate had dropped from 87 to 56% and a total decrease of 35.6% was observed. After 8 weeks of NS treatment the A/C rate dropped from 87 to 85% and a total decrease of 2.2% was observed.
In this study, the effect of fluticasone propionate nasal drops on adenoid hypertrophy is examined for the first time. This method provides an effective alternative to surgical treatment in children with adenoid hypertrophy. With the protocol applied in this study 76% of the patients were eliminated the surgery and removed from the surgical waiting list.
儿童腺样体肥大的治疗通常根据气道阻塞程度及相关发病率来规划。若需进行手术治疗，应从麻醉和术后并发症方面评估患者个体的风险/收益分析。尽管替代治疗方案较少，但在病情不太严重的情况下可将其视为非手术方法。因此，已有关于各种方案下鼻内应用类固醇的研究报道。
前瞻性、随机、安慰剂对照研究。
三级转诊中心。
拟行手术的患者被随机分为两组。研究组接受每日400微克丙酸氟替卡松滴鼻剂（NSD - 鼻用类固醇滴鼻剂）治疗，为期8周。对照组以同样方式接受生理盐水（NS）治疗。所有患者每4周进行一次随访。
8周结束时，与生理盐水治疗组相比，在鼻气道阻塞、口呼吸、言语异常、呼吸暂停及夜间咳嗽方面，接受NSD治疗的组有统计学显著改善（p<0.05）。8周结束时，NSD治疗组的平均总症状评分从13.7降至2.9，而生理盐水治疗组的评分从14.8变为14.6。NSD治疗8周后，初始腺样体/后鼻孔（A/C）比率从87%降至56%，总降幅为35.6%。生理盐水治疗8周后，A/C比率从87%降至85%，总降幅为2.2%。
本研究首次考察了丙酸氟替卡松滴鼻剂对腺样体肥大的影响。该方法为腺样体肥大儿童的手术治疗提供了一种有效的替代方案。采用本研究中的方案，76%的患者无需手术，从手术等候名单中移除。
