Efficacy and Safety of Montelukast Combined with Intranasal Mometasone Furoate versus Intranasal Mometasone Furoate Alone in in Treatment of Adenoid Hypertrophy: A Randomised Controlled Trial

Introduction: Children frequently have adenoidectomy, which has a risk of complications that include either early or late bleeding, recurrent enlargement of adenoids, and respiratory problems after surgery.Risks associated with anaesthesia are another consideration that needs to be taken into account.As a result, studies and investigations are being done into the pharmacotherapy for adenoid hypertrophy.Cysteinyl leukotriene receptor-1 modulates the inflammation process, and it has been extensively studied in the adenotonsillar tissues removed surgically from paediatric patients with obstructive sleep apnoea. Aims/ objective:To compare the efficacy and safety of intranasal mometasone furoate alone against intranasal mometasone furoate plus montelukast combination therapy for the pharmacotherapy of adenoid hypertrophy.Materials and Method: 50 patients were randomised in group M + M (given combination therapy of montelukast 5 mg for age ≥ 6years or 4 mg for age < 6years oral once daily + mometasone furoate 100 μg, 2 puff in each nostril) and group M (given mometasone furoate monotherapy) with 25 patients in each group.Using information from parents with special emphasis on snoring, rhinorrhoea, and mouth breathing, symptoms were scored using VAS (visual analogue scale) with scores ranging from 0 to 10.In order to conduct a clinical evaluation on each patient, radiographic testing and flexible fibro-optic endoscopic examination of the nasopharynx were also used.Results: Patients given montelukast + mometasone furoate combination therapy for 3 months have significantly better result with respect to decrease in rhinorrhoea, mouth breathing and snoring as compared with patients given mometasone furoate monotherapy (p<0.0001).There was nearly 15% decline in A/N ratio in patients receiving 3 months combination therapy as compared to only 5% decrease in patients receiving monotherapy.Recurrence rate was also lower in patients receiving combination therapy.Conclusion: Combination therapy of oral montelukast plus intranasal mometasone furoate was found to have better efficacy in patients of adenoid hypertrophy with respect to improvement in symptoms and reduction in adenoid size.