| Objective: To observe the clinical efficacy of nasal aerosol inhalation of glucocorticoid and nasal spray in the treatment of adenoid hypertrophy with chronic sinusitis in children,and to find a more effective way of local administration.Methods: From July 2019 to January 2020,the first affiliated Hospital of Fujian Medical University went to the outpatient clinic of Otorhinolaryngology,who complained of repeated snoring with open mouth breathing,nasal congestion and purulent nose for 3 months.explain the current condition to the children’s family in detail,and introduce the optional treatment plan(operation treatment and drug treatment).According to the inclusion criteria and exclusion criteria,the children who chose drug treatment were divided into two groups according to the random number table method.43 children were included in this study.20 patients in the spray group were treated with momethasone furoate spray,and 23 patients in the nebulizationgroup were treated with inhaled budesonide dry suspension.This study was examined and approved by the Ethics Review Committee of the first affiliated Hospital of Fujian Medical University(see Appendix 1),and the written informed consent of all the selected children’s families was obtained.Before treatment,all subjects were assessed by sinusitis quality of life scale(SNOT-5)and OSA-18,and objective examinations such as electronic nasopharyngoscope,PSG,nasal acoustic reflex,paranasal sinus CT were performed.The subjects were followed up at the 4th and 12 th week,and the SNOT-5 and OSA-18 scales were recorded at the 4th and 12 th week,respectively.At the 12 th week,electronic nasopharyngoscope,PSG,nasal acoustic reflex and paranasal sinus CT were reexamined.Among them,3 patients(nebulizationgroup 1,spray group 2)chose surgical treatment during follow-up,1 patient(nebulizationgroup)lost follow-up due to address change,and 1 patient(nebulizationgroup)dropped out of the study because of repeated URTI during follow-up.Results: In the nebulizationgroup at the 4th and 12 th week,the 0SA-18 score was significantly lower than that before treatment,the snoring with open mouth breathing symptoms were significantly improved,the SNOT-5 score was lower than the baseline,and the nasal congestion with purulent nose symptoms were significantly improved in the subjects with CRS.The adenoid volume decreased,AHI decreased,Lund-Mackay score decreased,NR decreased,NCV and NMCA increased,and the difference was statistically significant(P<0.05).At the 4th and 12 th week,the 0SA-18 score of spray group was significantly lower than the baseline,and the snoring and mouth-opening breathing symptoms of the subjects were significantly improved;the SNOT-5 score of the subjects with CRS was significantly lower than the baseline,and the symptoms of nasal congestion with purulent nose were significantly improved;the volume of adenoid decreased,AHI decreased,Lund-Mackay score decreased,NR decreased and NMCA increased,and the difference was statistically significant(P<0.05).At the 4th and 12 th week,the scores of SNOT-5 and 0SA-18 in nebulizationgroup were significantly lower than those in spray group,and the effect of nasal aerosol inhalation of corticosteroids on adenoid hypertrophy with or without CRS was better;the volume of adenoid in nebulization group was more significantly smaller than that in spray group;the scores of AHI,Lund-Mackay and NR in nebulizationgroup were significantly lower than those in spray group(P<0.05).Conclusion: Nasal inhalation of budesonide suspension reduced the volume of adenoid in children with adenoid hypertrophy and CRS,and the improvement of snoring with mouth breathing and nasal congestion with purulent nose was more significant than that of momethasone furoate nasal spray.No hormone-related adverse reactions and side effects were found during the follow-up period.Nasal aerosol inhalation of glucocorticoid can be used to improve the symptoms and even reduce the operation rate of adenoid hypertrophy in children with adenoid hypertrophy complicated with CRS. |
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