Fatih Alper AKCAN, Hümeyra Bayram AKCAN, Yusuf DÜNDAR, Ahmet ULUAT, Esra KARAKUŞ

Topikal Mometazon Furoat Kullanımının Adenoid Doku Üzerindeki Histopatolojik Etkisi

Amaç: Uykuda solunum bozukluğu (USB), birçok komorbidite riski taşıyan yaygın bir çocukluk çağı hastalığıdır. Çocukluk çağında USB'nun en sık görülen nedeni adenotonsiller hipertrofiye bağlı üst solunum yolu tıkanıklığıdır ve klasik tedavi adenotonsillektomidir. Bununla birlikte, birçok komplikasyon ve persistan apne riski taşır. Pediatrik USB tedavisinde topikal nazal steroid tedavisi cerrahiye alternatif olabilir. Bununla birlikte, topikal nasal steroidlerin histopatolojik etkileri yeterince anlaşılamamıştır. Gereç ve Yöntem: Çalışma üçüncü basamak bir sağlık merkezinde verilerin retrospektif olarak taranması şeklinde planlanmıştır. Çalışmaya USB nedeni ile adenoidektomi uygulanan toplam 110 çocuk dahil edildi. Çalışma grubuna 51 çocuk, topikal mometazon furoat monohidrat 100 mcg/gün ile tedavi edilmişti. Kontrol grubu (59 çocuk) rasgele seçildi ve preoperatif olarak topikal nasal steroid öyküsü yoktu. Ameliyat sonrası adenoidektomi örnekleri, akut/kronik inflamasyon bulguları, foliküler hiperplazi, goblet hücre hiperplazisi, skuamoz metaplazi, fibrozis, atrofi, ülser ve kanamaya göre gözden geçirildi. Bulgular istatistiksel analiz için semikantitatif olarak değerlendirildi.Bulgular: Çalışma grubunda kronik inflamasyon bulguları, foliküler hiperplazi ve goblet hücre hiperplazisi anlamlı olarak azalırken, fibrozis, atrofi ve ülser bulguları anlamlı olarak arttı. Bununla birlikte akut enflamasyon ve kanama açısından gruplar arasında istatistiksel olarak bir fark yoktu. Sonuç: Topikal nazal kortikosteroidler USB'de nazofaringeal inflamatuvar süreci önemli derecede bastırmaktadır. Bu tedavi, en azından hafif ve orta şiddette USB olan hastalarda cerrahiye alternatif olabilir.

Anahtar Kelimeler:

Uykuda Solunum Bozukluğu, Adenotonsillektomi, Nazal Kortikosteroid, Histopatolojİ

The Histopathological Findings of Adenoid Tissue After Topical Mometasone Furoate Implementation

Objective: Pediatric sleep disordered breathing (SDB) is a common childhood disease with a potential risk of several comorbidities. The most common cause of SDB in childhood is upper airway obstruction due to adenotonsillar hypertrophy and the classical treatment is adenotonsillectomy. However, it carries a risk of many complications and persistent apnea. Topical nasal steroid treatment may be an alternative to surgery in the treatment of pediatric SDB. However, histopathological effects of topical nasal steroids are mostly understudied. Methods: A retrospective controlled clinical study in an academic tertiary referral center. A total of 110 children were involved in the study who underwent adenoidectomy for the treatment of SDB. The study group (51-children) was treated with topical nasal mometasone furoate monohydrate 100 mcg/day. The control group (59-children) was selected randomly and all had no history of topical nasal steroid pre-operatively. Post-operative adenoidectomy specimens were reviewed according to acute/chronic inflammation findings, follicular hyperplasia, goblet cell hyperplasia, squamous metaplasia, fibrosis, atrophy, ulcer and hemorrhage. The findings were scored semiquantitatively for statistical analysis. Results: Chronic inflammation findings, follicular hyperplasia and goblet cell hyperplasia were significantly decreased in the study group in addition fibrosis, atrophy and ulcer findings were significantly increased in the study group. However, there was no statistical difference between the groups according to acute inflammation and hemorrhage. Conclusion: Topical nasal corticosteroids significantly suppress the nasopharyngeal inflammatory process in SDB. This treatment may be an alternative to surgery at least in patients with mild and moderate disease.

Keywords:

Sleep disordered breathing, adenotonsillectomy, nasal corticosteroid, histopathology,

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ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez