Effect of topical mometasone furoate on adenoidal lymphoid tissue: a light microscopic study.

BACKGROUND: Adenoid hypertrophy is a common cause of upper airway obstruction, and adenoidectomy is one of the most frequently performed operations in children. Topical nasal steroids can act directly on nasopharyngeal lymphoid tissue to decrease its reactive inflammatory changes and potentially reduce its size. OBJECTIVE: To study the light microscopic changes in adenoidal lymphoid tissue after one month of topical steroid use. METHODS: Twenty-six children with adenoid hypertrophy grade 3 scheduled for adenoidectomy were randomly divided into two equal groups: one group received mometasone furoate aqueous nasal spray (Nasonex) 100 mcg/day for four weeks, and a control group received nasal normal saline 0.9 per cent for four weeks. The removed adenoids were examined histopathologically. RESULTS: Adenoidal tissue from the mometasone group had less reactive germinal centres and less spongiosis compared to the control group. The latter showed proliferating, reactive, variable sized and shaped lymphoid follicles, with congested blood vessels in the interfollicular areas. CONCLUSION: The use of intranasal mometasone furoate aqueous nasal spray (Nasonex) for one month reduced adenoidal tissue reactive cellular changes and its vascularity. This is, however, a pilot study; a longer treatment period is needed to assess the effect of treatment on adenoidal size.

Correlation of obstructive sleep apnoea and laryngopharyngeal reflux: phmetry study.

OBJECTIVE: To study the correlation of obstructive sleep apnoea (OSA) and laryngopharyngeal reflux (LPR). DESIGN: A descriptive study. SETTING: Suez Canal University Hospital, Ismailia, Egypt. PATIENTS: 62 patients with polysomnography confirmed OSA. INTERVENTION: Patients were evaluated with ambulatory 24-h double channel pH monitoring. RESULTS: Mean reflux symptom index in the study group was 9 ± 5.5, and it was > 13 in all patients with severe OSA. Signs of LPR reflux were present in 34 (55%) patients. Abnormal reflux was detected in the distal oesophagus in 41 patients (66%) and in the proximal oesophagus in 21 patients (34%). Patients with severe OSA had significantly higher nocturnal LPR reflux episodes compared to patients with mild disease (P < .05). Number of reflux episodes and total duration of reflux during sleep are significantly correlated to degree of OSA (P < .05). No difference was found in relation to age or sex. Daytime reflux was not related to the degree of obstructive sleep apnoea (P > .05). CONCLUSION: LPR is common in patients with OSA. Patients with severe OSA have significantly higher nocturnal LPR. This should be considered when treating this group of patients.