Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
Adenoid hypertrophy and otitis media with effusion are very frequent indications for surgery in children. Otitis media with effusion is the commonest cause of their hearing difficulty.
A potential role of corticosteroids in the treatment of both diseases has emerged "6". Short-term use of systemic steroids provides a temporary improvement but long-term use of systemic steroids is not appropriate in children due to severe side-effects. On the other hand, topical nasal steroids without systemic side-effects might be used"7" .
OBJECTIVE:
To prove that intranasal steroid treatment can be a useful alternative to surgery in the treatment of children with otitis media with effusion and/or adenoid hypertrophy
PATIENTS AND METHODS:
A total of 68 children (4–14-year-old) on the waiting list for an adenoidectomy and/or myringotomy with or without ventilation tube placement were enrolled into the study and control groups. The study group (38 patients with adenoid hypertrophy, 19 of them with otitis media with effusion) received intranasal beclomethasone dipropionate (aqueous suspension) 168 mcg daily, and the control group (30 patients with adenoid hypertrophy, 16 of them with otitis media with effusion) was followed up without any treatment. All patients were evaluated at 0 and 8 weeks. The assessment of each patient included history, a symptom questionnaire, a tympanogram, a pure tone audiogram, and otoscopic examination and a plain radiograph (lateral soft tissue X-ray of postnasal space). The size of adenoid tissue was graded as a percentage according to obliteration of the airway of the postnasal space. The adenoid/postnasal (A/P) airway ratio was recorded for each patient. Symptoms were scored as 0 (absent), 1 (intermittent/periodic), or 2 (continuous). The data were analyzed with the “Statistical Package for the Social Sciences” (SPSS 9.0).
RESULTS:
Resolution of otitis media with effusion in the study group (41.6%) was significantly higher than that in the control group (13.3%) (p < 0.001). Twenty -six patients (68.4%) with adenoid hypertrophy in the study group showed a significant decrease in adenoid size according to the plain radiograph evaluation compared to the control group (p < 0.001). A significant improvement in obstructive symptoms was seen in the study group (p < 0.001). The radiographically measured adenoid/postnasal airway ratio and degree of obstructive symptoms showed a significant correlation (r = 0.838 p < 0.001, r = 0.879 p < 0.001, r = 0.838 p < 0.001, r = 0.879 p < 0.001).
CONCLUSION:
Nasal beclomethasone dipropionate treatment can significantly reduce adenoid hypertrophy and eliminate obstructive symptoms. It is a useful alternative to surgery (in good percentage of cases), at least in the short term (8weeks ), for otitis media with effusion.