Efficacy of combination therapy with mometasone and montelukast versus mometasone alone in treatment of adenoid hypertrophy in children: A systematic review and meta-analysis

Introduction: Intranasal mometasone and oral montelukast have been found to be effective for adenoid hypertrophy in children. We aimed to compare the efficacy of combination therapy of mometasone and montelukast versus mometasone alone for adenoid hypertrophy in children.

Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing combination therapy of mometasone and montelukast with mometasone alone for adenoid hypertrophy in children. The outcomes of interest were rhinorrhea, snoring, mouth breathing, and adenoid/nasopharynx ratio. Data were pooled using a random effects model to generate mean differences (MD).

Results: 3 RCTs comprising a total of 207 patients were included; (combination therapy n = 104 (50.2 %). Rhinorrhea (MD -1.47; 95 % CI -1.85 to -1.09; p < 0.01; I² = 0 %), snoring (MD -1.33; 95 % CI -1.65 to -1.00; p < 0.01; I² = 0 %), and mouth breathing (MD -1.06; 95 % CI -1.40 to -0.71; p < 0.01; I² = 0 %) were significantly lower in patients treated with combination therapy. No difference was observed in the adenoid/nasopharynx ratio between the groups. However, analysis excluding the study with a high risk of bias showed a significant reduction in the adenoid/nasopharynx ratio (MD -10.73; 95 % CI -13.56 to -7.90; p < 0.01; I² = 0 %) in the combination therapy group. During the 3-month follow-up period after cessation of treatment, adenoid/nasopharynx ratio, rhinorrhea, snoring, and mouth breathing were significantly lower in the combination therapy group.

Conclusion: In children with adenoid hypertrophy, combination therapy reduced rhinorrhea, snoring, mouth breathing, and adenoid/nasopharynx ratio at the end of the treatment period and 3 months after treatment cessation.