Intranasal Mometasone Furate, Montelukast and Azithromycin: Three Modalities of Adenoid Hypertrophy Treatment; A Comparative Study

Document Type : Original Article

Authors

otorhinolaryngology,faculty of medicine,al.azhar university

10.21608/aimj.2025.407143.2727

Abstract

Abstract
Background: While surgical intervention remains a common approach to adenoid hypertrophy (AH), medical therapies such as intranasal corticosteroids, leukotriene receptor antagonists, and macrolide antibiotics have shown promise.
Aim: To compare the effectiveness of intranasal mometasone furoate (MF), oral montelukast (MO), and oral azithromycin in improving symptoms and reducing adenoid size in children.
Methods: In this prospective comparative study, 60 children aged 2–14 years with grade 3 or 4 AH and an adenoid-to-nasopharynx (A/N) ratio >50% were randomized into three equal groups (n=20 each). Group 1 received MF nasal spray, Group 2 received oral MO, and Group 3 received oral azithromycin for six weeks.
Results: All three treatment modalities led to significant reductions in nasal obstruction and snoring (p<0.001). Significant improvements were also observed in sleep apnea (MF: from 3.0±0.0 to 0.8±1.19; MO: from 2.65±0.67 to 1.1±1.07; azithromycin: from 2.0±0.65 to 1.1±1.21; p<0.001), and rhinorrhea in Groups 1 and 2 (MF: from 1.4±1.23 to 0.6±0.82; MO: from 1.05±1.15 to 0.3±0.73; both p<0.001), but not in Group 3 (p=0.068). Cough significantly improved in Groups 1 and 2 (MF: from 1.0±1.29 to 0.6±0.82, p<0.001; MO: from 0.35±0.49 to 0.0±0.0, p<0.001), while no significant change was observed in Group 3 (p=0.085). Adenoid grade significantly decreased only in Group 1 (p<0.001), with no significant reduction in Groups 2 and 3 (p=0.25 and 0.198, respectively).
Conclusion: All three modalities demonstrated symptom improvement in children with AH; however, intranasal MF yielded the most consistent and significant reduction in both clinical symptoms and radiographic adenoid size.

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