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Leukotriene Modulator a Safe Pharmacological Option for Children with Adenoid Hypertrophy

by Linda Kossoff •

CLINICAL QUESTION

What is the role of the leukotriene receptor antagonist montelukast in the treatment of adenoid hypertrophy (AH)?

BOTTOM LINE

Montelukast used alone or in combination with intranasal mometasone furoate significantly improves clinical symptoms of AH.

BACKGROUND: Adenoid hypertrophy is a common cause of upper respiratory blockage in children. Adenoidectomy can remove enlarged adenoids, but given its associated costs and risks, medical treatment might be preferable. Leukotrienes play a significant role in the pathogenesis of AH, suggesting that a leukotriene receptor antagonist might play a role in nonsurgical treatment.

STUDY DESIGN: Literature study

SETTING: Department of Otolaryngology–Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.

SYNOPSIS: Researchers conducted a literature search and identified seven randomized clinical trials comprising 742 children (395 females) with AH who were treated with either the leukotriene receptor antagonist montelukast alone or montelukast in combination with the local intranasal steroid mometasone furoate. The main outcome measures were effect of montelukast on clinical symptoms of AH. Results showed that montelukast alone or in combination with intranasal mometasone furoate significantly improved symptoms of AH, including snoring, sleeping disturbance, mouth breathing, and adenoid/nasopharyngeal (A/N) ratio. Montelukast was superior to placebo in decreasing snoring, sleep discomfort, A/N ratio, and mouth breathing. No difference was detected between montelukast and mometasone versus mometasone alone in snoring; however, the combination group was superior to the mometasone alone in mouth breathing. Authors note that as an anti-leukotriene, montelukast may help improve clinical consequences of AH because of the abundance of leukotriene and their receptor expression, which is elevated in the adenotonsillar tissues of children with obstructive sleep apnea. They state that their findings support the use of a leukotriene modulator as a safe pharmacological option for children with AH. Study limitations included small sample size.

CITATION: Alanazi F, et al. Efficacy of montelukast for adenoid hypertrophy in paediatrics: A systematic review and meta-analysis. Clin Otolaryngol. 2024;49(4):417-428. doi: 10.1111/coa.14169.