Role of Mometasone Furoate as medical therapy in children with obstructive sleep apnea and adenoid hypertrophy

<bold>Introduction:</bold> Surgical therapy has long been considered the first-line treatment for children with Obstructive sleep apnea (OSA). Current evidence has led to a notable reduction in indications for adenotonsillectomy in favor of medical therapy with intranasal steroids treatment. <bold>Objective:</bold> to evaluate the effectiveness of Mometasone Furoate (MF) on symptoms and adenoid hypertrophy in children with OSA after 4 months of treatment. <bold>Material and methods:</bold> we recruited children with OSA referred to the pediatric fibroscopy service of Perugia hospital between April 2021 and March 2023. Inclusion criteriawere age 3-5 years, OSA diagnosis (mild-moderate on polysomnography), detection of adenoid hypertrophy, absence of syndromic or craniofacial anomalies, comorbidities (cardiologic, neuromuscular pathologies, etc.). <bold>Results:</bold> One hundred ninety-four patients (112 M, mean age = 4.3 ± 1.1 years, 16% obese) were recruited. One hundred forty-eight children (78%) obtained significative symptomatic improvement (6 operated 3%, 142 not operated 73%, p <0.001). The average adenoids score at the end of the observation period went from 3.02 to 2.09 (p<0.001). Thirty-eight children (20%) presented unchanged symptoms regardless of the adenoid score (28 operated 14.4%, 10 not operated 5.1%). Eight patients (4%) had worsening symptoms and stable adenoid grading. <bold>Conclusions:</bold> Our results demonstrated the effectiveness of MF. MF appears to be a useful therapeutic tool in the first-line management of children with adenoid hypertrophy and moderate to mild pediatric OSAS