Australian researchers have found that a simple nasal spray could halve the number of children needing to have their tonsils removed.
The research, led by the Murdoch Children’s Research Institute (MCRI) and published 18 January 2023 in JAMA Paediatrics, demonstrated that a saline (salt water) nasal spray was just as effective as an anti-inflammatory steroid nasal spray at easing sleep disordered breathing in children after six weeks of treatment.
The findings showed that both nasal sprays significantly reduced snoring and breathing difficulties in children while asleep in about 40% of cases, while the number of children assessed by a surgeon as needing their tonsils and/or adenoids removed was reduced by half.
Snoring and breathing difficulties during sleep affect about 12% of children and can cause significant long-term issues impacting cognitive function, behaviour, and cardiovascular health.
Currently, tonsillectomy is the most common paediatric elective surgery used to treat children’s snoring in Australia, with more than 40,000 performed each year, and the procedure is costly, painful and a significant burden on hospital resources.
Murdoch Children’s Dr Alice Baker highlighted that Victorian children typically waited more than a year in the public system for surgery to remove tonsils and adenoids, prompting a need to look for an alternative treatment for sleep disordered breathing.
“And some children may also be having their tonsils and adenoids out unnecessarily,” Dr Baker said.
“Nasal sprays work by cleaning the nose and/or reducing inflammation not just in the nose but all the way down the back of the throat to the adenoids and tonsillar tissue to alleviate the symptoms.
“Evidence from small clinical trials suggests that intranasal corticosteroids improve SDB as measured by polysomnography, however, the effect on symptoms and quality of life is unclear.”
The randomly controlled MIST trial of the sprays involved 276 children, aged 3-12 years, and was carried out at The Royal Children’s Hospital and Monash Children’s Hospital from 28 October 2020 to 25 September 2022.
To determine whether intranasal mometasone furoate was more effective than intranasal saline, for improving symptoms and quality of life in children with SDB, participants were randomly assigned to receive either 50 μg of mometasone furoate, or sodium chloride (saline) at 0.9% solution strength, with one spray per nostril daily, dispensed from identical bottles.
Murdoch Children’s Associate Professor Kirsten Perrett said the study found a substantial number of children with sleep disordered breathing could initially be managed by their GP and may not require referral to specialist services as currently recommended.
“A large proportion of children who snore and have breathing difficulties could be managed successfully by their primary care physician, using six weeks of an intranasal saline spray as a first-line treatment,” she said.
“Using this cheaper and readily available treatment would increase the quality of life of these children, reduce the burden on specialist services, decrease surgery waiting times and reduce hospital costs.”
Parents Stephen Graham and Emily Tuner-Graham said their seven-year-old son, Thomas, had stopped snoring and no longer needed his tonsils removed since taking part in the trial.
“From three years of age Thomas started snoring and we were concerned that he would eventually need surgery,” they said.
“Prior to joining the trial, a specialist recommended having his tonsils out. It is a such huge relief that by just using a nasal spray his breathing difficulties have cleared.”