Any Drs around??? Sorry Long

[SoupKitchen]

DS was seen in Ent clinic yesterday, with regard to various probs.
Snoring, green snot, mouth breathing, dribbling and delayed speech.
They did a brief hearing assessment and said his timpanums were not really moving, and would need a full hearing test, to assess for glue ear.

He has raised lymph node in his neck and head large but healthy tonsils. And the dr suspects very large adenoids.

We are to trial a steroid nasal spray for 6 weeks then go back and if no improvement be referred for adenoidectomy. BUT the spray Nasadex is not lisensed for under 6ys old, DS is 2.
He is already on Flixotide for his asthma and hydrocortisone for his eczema.

Is it safe for him to have this spray if it is not licensed and is that not a lot of steroids for such a long boy.

BTW the consultant did say he doesn't even expect the spray to work, but must use conservative measures first.

I have not yet given the spray. Do you think I should just give it or discuss it with my GP first.

Apologies for the long post

[Blandmum]

Not a doctor but used to work in the pharma industry.

Very few drugs are licenced to be used by kids. The reason is that to get a licenece you have to have large scale clinical trials whith kids, and that is very hard to get ethical approval.

Doctors use drugs off licence every day, not just for kids, but for adults too. legally they are responsible if something goes wrong, so you can bet your boots that they are careful.

Company I worked for marked an oetrsogen creme for use in post menopausal women., But it was used off licence to treat vaginal adhesions in young girls. therewere small scale clinical trials, docs knew that it was OK to use, but there wasn't enough infor (or money in it) to get a licence.

HTH

[SoupKitchen]

Thanks MB that, does reassure me about the actual spray, what do you think if anything about the steroid loading??

[Blandmum]

Nothing, sorry! I do know that the systemic absorbtion of steriods via inhalers isn't that large, and there would be even less absorbed systemically via the skin, but I never worked on steriod drugs

[Pinkveto]

Umm, not a pharmacologist, an anaesthetist, but the point of a nasal spray is to deliver direct to site required, so peak at that site will be high, but should minimise systemic absorption.

Obviously if you give a great big squirt he will swallow some, and absorb that, but the doses will be small, and some metabolised before reaching anywhere important. Also if he does have massive adenoids, they will have a good blood supply, and may carry a tiny bit off elsewhere.

However, if the ENT consultant has said this is the way they generally do things, i.e. a conservative approach with this spray for a trial, I would think that there has been consideration of the doses involved, and as MB says, steroid absorption by the other routes your son uses are small too.

So even cumulatively I would not be particularly concerned. Hydrocortisone is only a weak steroid too, so even if you are slathering him in that twice a day, he is not receiving much - bear in mind that if his skin flares he would have a spell of Eumovate or Betnovate which can get rather poky.

Any consolation, my LO has been on twice daily Eumovate since Jan, and it does cross my mind occasionally that it is not ideal.

[Millarkie]

Also not a doctor but I have a ds who was just like yours 5 years ago (ds now 7). He still has glue ear (had adenoidectomy at age 3 and grommets which blocked after 3 months, another lot of grommets 2 years ago which stayed open and made a huge difference)...he has an ear infection this week (burst eardrum because grommets are out now). He also has a chronic runny nose (well, nostril actually, t'other side is fine) so we took him to the GP to check the ear infection but also asked for something to help with the runny nose - GP refused to give him a steroid nasal spray (which had been previously prescribed by ENT at hospital) because ds also has steroid inhaler for asthma (also has hydrocortisone for excema flare-ups but have not had any recently)...he gave him daily anti-histamine liquid instead which has made a huge difference to his nose (thank goodness) - although GP thinks ENT will re-do the grommets soon.
Hope your son gets some relief from his glue ear soon.

[SoupKitchen]

Thanks for the replies.On balance I suppose it is short term and as a couple of people have said absorbtion should be small.
I guess I will be spraying his nose tomorrow

[SoupKitchen]

Millarkie - Our DSs sound very similar indeed

[emma1977]

Off-license prescribing is wide-spread in kids for the reasons that MB outlined.

Nasonex has a good safety record and delivers a relatively small amount of steroid to the needed site. The combined amount of steroid which your ds would be exposed to overall with his other meds would not be enough to cause any long-term problems.