Shokouhi Farshid, Meymaneh Jahromi Ahmad, Majidi Mohamad Reza, Salehi Maryam
Department of Otorhinolaryngology, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.
Sinus and Surgical Endoscopic Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Iran J Otorhinolaryngol. 2015 Nov;27(83):443-8.
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.
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.
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.
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.
腺样体扁桃体肥大（AH）被认为是儿童上呼吸道梗阻的最常见原因。它会导致一系列症状，从口呼吸、鼻塞、鼻音过重、打鼾和阻塞性睡眠呼吸暂停（OSA）到生长发育迟缓以及心血管疾病。腺样体扁桃体切除术是治疗AH患者的一种典型策略，但可能会导致严重并发症，如出血（4 - 5%）和术后呼吸功能不全（27%），尤其是在幼儿中，以及腺样体组织复发（10 - 20%）。因此，非手术治疗作为一种替代策略已引起相当大的关注。针对AH提出的炎症机制促使人们使用抗炎药物来治疗这种疾病。本研究旨在评估半胱氨酰白三烯受体拮抗剂孟鲁司特咀嚼片对AH儿童的疗效。
在这项随机、安慰剂对照试验中，招募了60名年龄在4至12岁之间、初次鼻内镜检查显示后鼻孔阻塞>75%的儿童，并将其随机分为两组。研究组每天服用5毫克孟鲁司特，持续12周，而对照组在同一时期服用匹配的安慰剂。每个孩子的家长/监护人填写一份问卷，以评估干预前后睡眠不适、打鼾和口呼吸的严重程度。
12周后，研究组76%的患儿腺样体大小减小，而安慰剂组这一比例为3%。与安慰剂组相比，研究组在睡眠不适、打鼾和口呼吸方面有统计学上的显著改善。研究组症状平均总分从7.7降至3.3，而安慰剂组总分从7.4变为6.7。
孟鲁司特咀嚼片可显著减小腺样体大小，并改善AH的相关临床症状，因此可被视为腺样体肥大儿童手术治疗的有效替代方法。
