Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, University Hospital No 2, Ujejskiego Street 75, 85-168, Bydgoszcz, Poland.
Department of Immunology, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, 87-100, Torun, Poland.
Eur Arch Otorhinolaryngol. 2024 May;281(5):2477-2487. doi: 10.1007/s00405-024-08459-6. Epub 2024 Jan 31.
This study aimed to examine the effectiveness of the combined maximal medical treatment for adenoid hypertrophy in preschool children.
Sixty-four children underwent one-year combined therapy with intranasal mometasone furoate, oral desloratadine, nasal saline irrigation, and bacteriotherapy. Additionally, decongestion drops were applied during scheduled breaks.
Of the 64 treated children, 72% showed clinical improvement in adenoid symptoms while 28% did not improve and underwent surgery. These groups differed significantly in terms of the overall reduction in ailments after treatment (p < 0.001), infection rate (p < 0.001), catarrh severity (p < 0.001) and nasal patency (p < 0.001). Endoscopic examination confirmed that responders experienced, on average, a decrease of 8.4% in the adenoid/choana ratio and an improvement in mucosal coverage of the adenoid. These effects were not observed in the group of children whose parents opted for surgery after nine months of conservative treatment.
The proposed new schema of long-term maximal medical treatment with the use of combined intermittent treatment of intranasal mometasone furoate and decongestion drops, oral desloratadine, nasal saline irrigation, and bacteriotherapy can be attempted in patients with adenoid hypertrophy symptoms, and responders may avoid the need for surgery. The applied treatment breaks resulted in a low number of therapeutic side effects.
本研究旨在探讨联合最大药物治疗对腺样体肥大学龄前儿童的疗效。
64 名儿童接受为期一年的联合治疗，包括鼻腔内使用糠酸莫米松、口服地氯雷他定、鼻腔盐水冲洗和细菌治疗。此外，在规定的休息时间使用减充血滴剂。
在 64 名接受治疗的儿童中，72%的儿童腺样体症状得到临床改善，28%的儿童未改善并接受了手术。这两组在治疗后整体疾病缓解程度（p<0.001）、感染率（p<0.001）、卡他严重程度（p<0.001）和鼻腔通畅度（p<0.001）方面存在显著差异。内镜检查证实，应答者的腺样体/后鼻孔比率平均降低 8.4%，腺样体黏膜覆盖得到改善。而在接受 9 个月保守治疗后选择手术的儿童组中未观察到这些效果。
对于腺样体肥大症状的患者，可以尝试采用长期最大药物治疗的新方案，联合间歇性鼻腔内使用糠酸莫米松和减充血滴剂、口服地氯雷他定、鼻腔盐水冲洗和细菌治疗，如果应答者可以避免手术。应用的治疗休息期导致治疗副作用的数量较低。
