Chronic nonallergic rhinitis in children: Role of adenoidal hypertrophy

Abstract

Rationale The contribution of adenoidal hypertrophy (AH) to nasal symptoms of non-allergic rhinitis (NAR) is unknown. The primary outcome of this study was the prevalence of adenoidal hypertrophy in children with NAR. Secondary outcome was ability of intranasal glucocorticoids (INS) to reduce AH and related symptoms. Methods Symptoms suggesting allergic rhinitis were found in 294 children aged 1-15 years. Those with negative skin tests (ST) to a panel of environmental allergens, and AH on lateral neck X-ray were the study group. The benefit of INS was assessed by symptom score comparisons before and after therapy and X-ray changes. Results Negative ST were found in 147/294 (50%) of subjects who were then diagnosed with NAR. Of these 41/147 (28%) had AH. In the AH group symptoms included rhinorrhea 26/41 (63%), snoring 20/41 (48%), mouth breathing 18/41 (43%), nasal congestion 18/41 (43%), recurrent sinusitis/otitis media 7/41 (17%). Of AH patients 35/41 (85%) were treated with INS resulting in 18/35 (51%) reporting symptomatic improvement, and 5/35 (14%) being unchanged; in 12/35 (34%) there is no follow up. Repeat X-rays were done in 7/35 (20%) and revealed improvement of adenoid size in 2/7 (28%), no change in 3/7 (42%) and further enlargement in 1/7 (14%). Conclusions Our study reveals that AH is often associated with NAR in children. Use of INS leads to symptomatic improvement in approximately 50% of cases, and may reduce adenoidal size in a subset of cases. In children with NAR a trial of INS therapy seems reasonable prior to surgical intervention.