鼻用类固醇治疗儿童变应性鼻炎伴腺样体肥大疗效分析

目的 探讨儿童变应性鼻炎(AR)与腺样体肥大的关系, 评价鼻用类固醇治疗儿童变应性鼻炎伴腺样体肥大的疗效。方法 对照组为单纯腺样体生长儿童261例, 其中腺样体肥大190例(72.7%)。观察组为变应性鼻炎伴腺样体生长儿童162例, 其中腺样体肥大110例(67.2%)。两组均给予鼻用类固醇(丙酸氟替卡松喷剂)持续喷鼻3个月后于鼻内镜下复查。结果 对照组并发腺样体肥大构成比为72.7%,观察组并发腺样体肥大构成比为67.2%, 差异无统计学意义(χ²=1.16, P>0.05)。对照组采用鼻用类固醇治疗后有效腺样体体积减少112例(58.9%),观察组有效腺样体体积减小89例(80.9%)(χ²=19.04, P<0.01)。结论 经鼻用类固醇治疗, 变应性鼻炎伴腺样体肥大患儿腺样体体积减小程度较单纯腺样体肥大患儿明显。对变应性鼻炎合并腺样体肥大者可优先考虑应用鼻用类固醇激素。     

丙酸氟替卡松鼻喷剂对伴和不伴变应性鼻炎的腺样体肥大儿童的疗效比较

目的探讨儿童变应性鼻炎(allergic rhinitis,AR)与腺样体肥大两者关系,以及治疗的相互联系。方法选取腺样体肥大患儿98例,其中单纯腺样体肥大患儿52例(53.1%),腺样体肥大合并变应性鼻炎患儿46例(46.9%)给予辅舒良(丙酸氟替卡松喷剂)持续喷鼻3月。结果单纯腺样体肥大儿童52例,治疗后有效腺样体体积有效减小31例,有效率为59.6%。腺样体肥大伴变应性鼻炎儿童46例,治疗后有效腺样体体积有效减小38例,有效率为82.6%。两组有效率比较有显著差异(χ2=18.04,P0.01)。结论儿童腺样体肥大是多因素结果。变应性鼻炎炎症因子是大龄儿童腺样体肥大的主要发病机制之一。儿童腺样体肥大合并变应性鼻炎儿童可经鼻用糖皮质激素治疗后腺样体体积减小程度较单纯腺样体肥大患者明显,对儿童变应性鼻炎合并腺样体肥大优先考虑鼻类固醇激素治疗过敏性鼻炎。     

儿童腺样体肥大并发分泌性中耳炎与变应性鼻炎发病的相关性分析

目的:分析儿童腺样体肥大群体中并发分泌性中耳炎(OME)与变应性鼻炎(AR)发病之间的相关性。方法:回顾性分析287例腺样体肥大患儿中并发OME的发病情况,有无AR病史,有无鼻类固醇激素使用病史等资料。结果:所有腺样体肥大患儿在不考虑鼻类固醇激素的作用下,伴AR组和不伴AR组中OME发生率分别为25.56%和32.47%,二者差异无统计学意义(χ2=1.643,P>0.05)。对未使用鼻类固醇激素治疗的患儿进行分组分析,伴AR组OME发病率为51.11%,明显高于对照组(32.26%)(χ2=5.019,P<0.05)。伴AR患儿中,使用鼻类固醇激素组中OME发生率为12.50%,明显低于不使用鼻类固醇激素组中OME的发生率(51.11%)(χ2=23.32,P<0.01)。结论:腺样体肥大患儿中OME的发病率较高,其中AR是影响OME发病的一个重要因素。鼻腔类固醇激素的使用可以减少OME的发病率,对中耳炎的治疗有一定效果,具体疗效评估及治疗机制尚需进一步研究。     

腺样体肥大与儿童鼻窦炎相关性及鼻用激素治疗的作用

腺样体肥大(adenoidal hypertrophy)是儿童最常见的疾病之一,可导致双侧鼻堵、流涕、咳嗽、打鼾、睡眠呼吸暂停等症状,通常认为其与儿童鼻窦炎的发病密切相关,但具体作用并不明确.腺样体切除术是腺样体肥大最常见的外科治疗手段,但目前仍存在术后出血、腺样体复发等风险.因此,许多学者开始研究鼻用激素对于腺样体肥大的治疗作用.本文就腺样体肥大在儿童鼻窦炎发病中的作用及鼻用激素对其治疗作用进行综述.     

鼻内镜经鼻电动切割与微波热凝治疗儿童腺样体肥大疗效的比较

目的比较鼻内镜电动切割与微波热凝经鼻治疗儿童腺样体肥大的疗效.方法在鼻内镜和电视监视下经鼻分别采用电动切割及微波热凝治疗儿童腺样体肥大各36例,治疗由于腺样体肥大引起的儿童睡眠呼吸障碍、鼻阻塞和咽鼓管功能障碍.结果电动切割术后腺样体切除彻底,无残体存留,鼻咽部结构显示良好,无咽鼓管损伤等并发症发生,随访1～2年,患儿症状消失或明显减轻,治疗有效率为100%.微波热凝术后腺样体切除不彻底,仍有残体存留,有咽鼓管损伤等并发症发生,随访1～2年,患儿治疗有效率为83.9%.结论鼻内镜下经鼻电动切割治疗儿童腺样体肥大的疗效优于微波热凝.     

孟鲁司特钠与鼻用激素治疗儿童腺样体肥大的Meta分析[论著]

目的　系统评价孟鲁司特钠与鼻用激素治疗儿童腺样体肥大的疗效。方法　计算机检索PubMed、EMbase、The Cochrane Library、OVID数据库，纳入孟鲁司特钠与鼻用激素治疗儿童腺样体肥大的研究。采用RevMan5.3软件包对纳入文献进行Meta分析。结果　最后纳入5篇随机对照研究。口服孟鲁司特钠治疗腺样体肥大治疗后的A/N比值明显低于治疗前的A/N比值[MD=-0.24，95%CI（-0.31，-0.17），P <0.0001]。口服孟鲁司特钠联合鼻用激素治疗腺样体肥大治疗后的A/N比值明显低于治疗前的A/N比值[MD=-0.25，95%CI（-0.28，-0.21），P <0.0001]。口服孟鲁司特钠组与鼻用激素组治疗后的A/N比值减小度差异不大[MD=-0.00，95%CI（-0.02，0.01），P =0.59]。联合治疗组治疗腺样体肥大后的A/N比值减小度较口服孟鲁司特钠组更明显，差异有统计学意义 [MD=-0.04，95%CI（-0.06，-0.02），P <0.0001］。单一用药或联合用药，打鼾、睡眠障碍、张口呼吸等症状均有改善。结论　口服孟鲁司特钠及鼻用激素均能有效治疗腺样体肥大儿童患者，二者联合治疗明显优于单纯一种药物治疗。短期内使用药物有效，长期研究尚未报道，需进一步研究。     

非手术方法治疗儿童腺样体肥大的临床观察

目的:探讨非手术方法治疗儿童腺样体肥大的可行性。方法:将57例腺样体肥大患儿分为实验T1组、T2组及对照组,分别应用鼻内糖皮质激素、白三烯受体拮抗剂及生理海水治疗12周,分析各组治疗前后腺样体大小及症状评分的变化。结果:T1和T2组在应用糖皮质激素喷鼻或口服白三烯受体拮抗剂治疗12周后,与对照组相比,临床症状显著改善,差异有统计学意义。T1及T2组腺样体的大小有相当程度的减小,而对照组无明显改变。T1与T2组疗效差异无统计学意义。结论:糖皮质激素喷鼻和口服白三烯受体拮抗剂对改善儿童腺样体肥大均可产生有益的作用,建议已有症状的腺样体肥大的学龄前儿童,在考虑手术治疗前,可首先应用鼻内糖皮质激素或白三烯受体拮抗剂治疗至少12周。     

鼻内窥镜下息肉切割器腺样体切除术

目的 探讨在鼻内窥镜下用微型息肉切割器切除肥大腺样体的效果。方法 对7例腺样体增生儿童,在鼻内窥镜下用息肉切割器行腺样体切除术,对照手术前后的治疗效果。结果 术后张口呼吸及打鼾全部消失,随访3月～2年无复发,伴渗出性中耳炎者辅以中耳穿刺治疗而治愈,鼻窦炎症状减轻．均无并发症出现。结论 鼻内窥镜下用息肉切割器行腺样体切除术是一种安全有效的手术方法。     

腺样体铲除术对咽鼓管功能影响的研究

目的:观察鼻内镜下经口腔腺样体铲除术与传统腺样体铲除术对腺样体肥大患者咽鼓管功能的影响。方法:选取诊断为腺样体肥大且不伴中耳炎的住院患者为研究对象,分别采用鼻内镜下经口腔腺样体铲除术和传统腺样体铲除术,在治疗前及治疗3个月后分别检测咽鼓管功能。结果:2组患者治疗前咽鼓管功能检查无统计学差异,治疗后与术前相比,2组均有统计学差异;治疗后2组之间差异也有统计学意义。结论:鼻内镜下经口腔腺样体铲除术和传统腺样体铲除术均可改善腺样体肥大患者的咽鼓管功能,且鼻内镜下经口腔腺样体铲除术对咽鼓管功能的改善优于传统腺样体铲除术。     

类固醇鼻喷剂治疗腺样体肥大

腺样体肥大引起儿童阻塞性睡眠呼吸暂停低通气综合征的发病机制不明,可能是和淋巴细胞亚群的改变及局部免疫功能紊乱有关.利用类固醇鼻喷剂治疗腺样体肥大不仅可以降低腺样体厚度与鼻咽腔宽度的比值,而且能解除患者的鼻阻塞状况.然而类固醇鼻喷剂治疗腺样体肥大的作用机制尚不明确,较公认的是基冈效应途径,非基因的受体介导效应途径仍在探索...     

Long-term follow-up of children undergoing topical intranasal steroid therapy for adenoidal hypertrophy

BACKGROUND: Encouraging results concerning chronic obstructive nasal symptoms due to adenoid in pediatric population were reported by use of intranasal steroid for short period. Up to now, no data are available about outcomes of such therapy after long-term follow-up. We evaluated the utility of mometasone furoate aqueous nasal spray in children with adenoidal hypertrophy in long-term maintenance therapy. METHODS: All children affected by adenoidal hypertrophy and undergoing successful mometasone treatment for 4 months in a preceding trial were reassessed after a mean follow-up of 28 months. Based on the duration of maintenance therapy and eventual adenoid surgical treatment, three subgroups were identified: (1) children voluntarily suspending maintenance therapy and requiring surgery (Group A); (2) children continuing maintenance therapy but undergoing surgery (Group B); and (3) children continuing maintenance therapy but not undergoing surgery (Group C). Clinical and endoscopic evaluation in each group was compared to the assessment performed after the first 4 months of treatment. RESULTS: Six patients (Group A) voluntarily suspended maintenance therapy and underwent adenoidectomy. Either the overall symptom score or choanal obstruction of this group worsened compared to the previous trial. Adenoidal surgery was performed in another three children (Group B) for ear disease. Chronic obstructive nasal symptoms and adenoid size were unchanged compared to the preceding study. Finally, 12 patients were in Group C. The overall symptom score and choanal obstruction of this group showed a further significant improvement at this stage. CONCLUSIONS: This study describes the first long-term follow-up of children undergoing mometasone furoate aqueous nasal spray treatment for adenoidal hypertrophy. Voluntary suspension of maintenance therapy favors surgery of this disorder, whereas its regular administration may lead to successful results.     

舌下含服粉尘螨滴剂联合鼻用激素治疗变应性鼻炎疗效观察

目的 评估舌下特异性免疫治疗联合鼻用激素治疗变应性鼻炎的疗效。方法 将能坚持治疗并定期随访的90例对粉尘螨过敏的变应性鼻炎患者资料纳入研究,随机分为两组,其中60例接受舌下免疫治疗(SLIT)联合鼻用激素治疗,另30例只用鼻用激素治疗,分别记录两组患者治疗前及治疗后6、12个月的症状评分(鼻痒、喷嚏、流涕、鼻塞症状评分)和症状总评分。结果 两组治疗后鼻炎症状均有显著改善,差异有统计学意义(P<0.05);联合治疗组12个月后较治疗6个月后鼻炎症状改善更显著(P<0.05),而单用激素组未再有明显改善(P>0.05);联合治疗组较单用激素组无论6个月后还是12个月后症状改善均更为显著(P<0.05)。结论 舌下特异性免疫治疗联合鼻用激素治疗变应性鼻炎较单用激素更为有效。     

咽鼓管球囊扩张联合腺样体切除术治疗儿童分泌性中耳炎疗效分析

目的 探讨咽鼓管球囊扩张联合腺样体切除术治疗儿童分泌性中耳炎的中短期疗效及安全性.方法 回顾性分析2020年7月至2021年2月就诊的分泌性中耳炎伴腺样体肥大患儿66例,其中35例采用咽鼓管球囊扩张联合腺样体切除术为治疗组,31例采用单纯腺样体切除术为对照组,比较两组术后疗效及并发症发生比例.结果 术后1个月、3个月治...     

Caldwell-Luc operation in the treatment of childhood bronchial asthma

A follow-up study was carried out in 15 children with severe bronchial asthma. Chronic infection of the paranasal sinuses was connected with the unfavorable course of their bronchial asthma. As adenoidectomy and intranasal antrostomy had failed to cure the sinusitis, the Caldwell-Luc operation was performed at the age of 6–16 years. The follow-up examination was done 3–12 years after the radical operation of the maxillary sinuses. The majority of the patients had normal working capacity, and the need of medical treatment was reasonable. It is concluded that the Caldwell-Luc operation is indicated in children with severe bronchial asthma, when repeated respiratory infections are associated with asthmatic attacks and adenoidectomy and intranasal antrostomy have proved ineffective.     

Nasal carriage of Staphylococcus aureus in children with allergic rhinitis and the effect of intranasal fluticasone propionate treatment on carriage status

OBJECTIVE: The aim of this study is to determine the rate of nasal carriage of Staphylococcus aureus (NCSA) in children with allergic rhinitis (AR) and to determine the effect of intranasal fluticasone propionate spray on the NCSA. PATIENTS AND METHODS: Nasal swabs were taken from the children admitted to general pediatrics and pediatric pulmonology clinics. Patients were divided into two groups according to the presence or absence of AR. Diagnosis of AR was based on the patient's symptoms. Nasal swabs were taken from AR patients before and after the treatment with intranasal fluticasone propionate, and from the control group at the beginning and after 2 months. RESULTS: Whole NCSA rate was 17.9%; it was 21.4% for AR patients and 15.9% for control group, respectively (p>0.05). Treatment with intranasal fluticasone propionate spray did not influence NCSA in AR patients. CONCLUSION: It seemed that NCSA was not increased in children with AR and treatment with intranasal fluticasone propionate spray did not change NCSA in AR patients. It is obvious that better understanding of the factors affecting the acquisition and loss of NCSA might increase our knowledge about the relationship between NCSA, allergic airway diseases and their treatments.     

Severe nasal polyposis and its impact on quality of life. The effect of a short course of oral steroids followed by long-term intranasal steroid treatment

OBJECTIVES: Nasal polyposis is not a life-threatening disorder but has a great impact on the quality of life. Steroids constitute the first line of treatment of nasal polyps. The aims of this study were to evaluate the quality of life in nasal polyp patients after: (1) a short course of oral steroids; and (2) a long-term treatment with intranasal steroids. METHODS: Patients with severe nasal polyps received either oral prednisone (n = 60) or no steroid treatment (control group, n = 18) for 2 weeks. Patients treated with steroids were also followed-up and evaluated after 12, 24, and 48 additional weeks with intranasal budesonide treatment. RESULTS: Patients with nasal polyps showed worse scores on all SF-36 domains, except for physical functioning, compared to the Spanish general population. After two weeks, patients treated with oral prednisone demonstrated a significant improvement (p < 0.05) in all impaired QoL domains compared to both control group and baseline. The mental component summary (51.0 +/- 1.2, p < 0.05) and physical component summary (51.0 +/- 0.9, p < 0.05) were improved compared to both control group and baseline. The improvement of all SF-36 domains was sustained by intranasal budesonida (p < 0.05) after 12, 24, and 48 weeks. Nasal obstruction, sense of smell, and polyp size also improved after both the oral short course and the intranasal long-term steroids treatment (p < 0.05). CONCLUSION: These results suggest that the treatment with a short-course of oral steroids improves the quality of life of patients with severe nasal polyps and that this effect is maintained by a long-term treatment with intranasal steroids.     

Pharmacotherapy focusing on for the management of otitis media with effusion in children: Systematic review and meta-analysis

ObjectiveTo examine the evidence for treating children with otitis media with effusion with pharmacotherapy.Data SourcesFor the systematic review, data were retrieved from PubMed, Cochrane database, and the Japan Medical Abstracts Society Database (1st January 1995 through 31th May 2019).Study SelectionArticles addressing pharmacotherapy for the management of otitis media with effusion in children were selected in English.Data ExtractionThe database was searched using the keywords “Otitis Media with effusion or secretory otitis media” and the following medical agents: carbocysteine, antihistamines, leukotriene receptor antagonist, and steroid nasal spray.Data SynthesisAfter a critical review of 18 studies, studies addressing steroid nasal spray were eligible for quantitative synthesis. Intranasal steroids for OME showed no benefit with OR 1.155 (95% CI 0.834-1.598) within one month. Conversely, intranasal steroids have effects for OME with OR 1.858 (95% CI 1.240-2.786) for more than one month.ConclusionsWe found evidence of benefit from treatment of OME in children with intranasal steroids and S-carboxymethylcysteine at longer-term follow-up.     

Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy

OBJECTIVES: To quantify the incidence of intranasal extension of adenoid tissue and residual adenoidal obstruction of the posterior choanae following traditional curette adenoidectomy to determine the efficiency of adenoid curettage and the usefulness of intraoperative endoscopic examination and powered-shaver adenoidectomy in achieving better postnasal patency. DESIGN: Prospective intraoperative endoscopic evaluation of the posterior choanae and nasopharynx of a case series of 130 patients before and after curette and powered-shaver adenoidectomy. SETTING: Tertiary referral center. PATIENTS: One hundred thirty consecutive pediatric patients with obstructive adenoidal hypertrophy undergoing adenoidectomy. MAIN OUTCOME MEASURES: The degree of residual postnasal obstruction due to adenoid tissue was assessed endoscopically (grades 0-3) after curette and adjuvant powered-shaver adenoidectomy. The presence of intranasal adenoid tissue was also recorded. RESULTS: Following traditional curette adenoidectomy, 51 (39%) of 130 patients had residual obstructive adenoid with 42 patients (32%) having occlusive intranasal adenoid tissue. Having determined the presence of remaining obstructive tissue with intraoperative nasal endoscopy in these 51 patients, complete airway patency was achieved with powered-shaver adenoidectomy. CONCLUSION: The presence of intranasal extension of adenoids obstructing the posterior choanae is common in children with adenoid hypertrophy. Traditional adenoidectomy is ineffective in removing this tissue and may also leave obstructive tissue high in the nasopharynx. Intraoperative nasal endoscopy allows assessment of the completeness of surgery. Powered-shaver adenoidectomy enables complete removal of obstructive adenoid tissue thereby ensuring postnasal patency.     

Effects of beclomethasone dipropionate nasal spray on subjective and objective findings in perennial allergic rhinitis

Effects of beclomethasone dipropionate nasal spray on subjective and objective findings in perennial allergic rhinitis It was the aim of this trial to study the effect of intranasal beclomethasone dipropionate on symptoms and signs of perennial allergic rhinitis in Japanese patients. In a multicenter trial 183 patients, children and adults, were treated with placebo or with 400 μgbeclomethasone dipropionate a day for 2 weeks. The active treatment had an effect on all nasal symptoms: sneezing, nose blowing, and blockage being reduced to 34%, 44% and 63% (P <0 01) of the values in the placebo group. A considerable carry-over effect was found, suggesting a group comparative design to be preferable for a cross over trial for the study of intranasal steroids. The beclomethasone dipropionate therapy had a significant inhibitory effect on the immediate response to nasal allergen provocation. The number of secretion eosinophils was reduced during treatment, and the appearance of the mucous membrane tended to normalize. Local side effects were few and insignificant. It is concluded that beclomethasone dipropionate is a valuable drug for the treatment of perennial allergic rhinitis.     

Mometasone furoate intranasal spray is effective in reducing symptoms and adenoid size in children and adolescents with adenoid hypertrophy

IntroductionThe use of mometasone furoate (MF) intranasal spray in treating adenoid hypertrophy (AH) has a variable outcome due the different methods of adenoid size evaluation. The aim of our study was to evaluate the effect of MF intranasal spray in children and adolescents with AH using a reliable and consistent endoscopic evaluation.Material and methodA prospective interventional study was conducted. Evaluation took place during the first visit (week 0) and second visit (week 12). Symptoms of nasal obstruction, rhinorrhoea, cough and snoring were assessed, and an overall total symptoms score was obtained. A rigid nasoendoscopic examination using a four-grading system of adenoid size from 1 to 4 was performed. Patients were treated with MF intranasal spray for 12 weeks. Patients’ aged 7–11-years old used 1 spray in each nostril once daily, while patients aged 12–17 used two sprays in each nostril once daily. Reassessment was carried out during the second visit (week 12).ResultsA total of 74 patients was recruited. There were significant improvements from week 0 to week 12 in the symptoms’ score for nose obstruction, rhinorrhoea, cough, snoring including the total nasal symptoms’ score (p < 0.001). AH significantly reduced in size from week 0 (2.89 ± .87) to week 12 (1.88 ± .83) (p < 0.001).ConclusionMF intranasal spray is effective in improving the symptoms attributed to AH as well as reducing the adenoid size. MF intranasal spray is advocated as a treatment option before adenoidectomy is considered.