title: Frequency of surgery among children who have adenotonsillar hypertrophy and improve after treatment with nasal beclomethasone.
abstract: OBJECTIVE
  To describe the long-term outcome of a cohort of children with symptomatic adenotonsillar hypertrophy treated with aqueous nasal beclomethasone.
  
  
  METHODS
  The children enrolled completed a 4-week single-blind, saline solution controlled crossover study of aqueous beclomethasone (total: 400 micro g/d). In a 24-week open-label follow-on study, beclomethasone 200 micro g/d was offered to all patients. During a 100-week follow-up, the degree of nasal obstruction and the frequency of adenotonsillectomy were assessed.
  
  
  RESULTS
  Fifty-three children of the 60 enrolled completed the study. After the 4-week crossover trial, the severity of nasal obstruction of 24 children (45%) significantly decreased during the use of nasal steroids, but no child improved when saline solution was used. At 24, 52, and 100 weeks, the 24 children who had initially improved showed a significant decrease of the severity of nasal obstruction and of the frequency of adenotonsillectomy (54% vs 83%) compared with the 29 children who had not responded after the initial steroidal therapy.
  
  
  CONCLUSIONS
  Evidence from this study suggests that 45% of children with adenoidal hypertrophy improved after 2 weeks of steroidal therapy. Among these children, an additional 24-week treatment at a lower steroid dosage was associated with a significant 52- and 100-week clinical improvement and with reduction of adenotonsillectomy compared with children (55%) who had not responded after the initial 2-week steroidal therapy.
authors.affiliation: Dipartimento di Pediatria, Università di Napoli Federico II, Napoli, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Criscuoli
authors.forename: Stefania
authors.initials: S
authors.lastname: D'Amora
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ripa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cinquegrana
authors.forename: Nicola
authors.initials: N
authors.lastname: Mansi
authors.forename: Nicola
authors.initials: N
authors.lastname: Impagliazzo
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pisacane
mesh_terms: D000233:Adenoidectomy / Q000706:statistics & numerical data*; D000234:Adenoids / Q000187:drug effects* / Q000601:surgery*; D000281:Administration, Intranasal; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001507:Beclomethasone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D006984:Hypertrophy / Q000188:drug therapy / Q000601:surgery; D008297:Male; D015508:Nasal Obstruction / Q000188:drug therapy* / Q000601:surgery*; D014066:Palatine Tonsil / Q000187:drug effects* / Q000473:pathology* / Q000601:surgery; D010865:Pilot Projects; D014068:Tonsillectomy / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D001507:Beclomethasone