Child being given nasal spray

A simple nasal spray significantly reduced snoring and breathing difficulties in children and halved the number needing to have their tonsils removed, according to a new study.

The research, led by the Murdoch Children’s Research Institute and published in JAMA Pediatrics, found 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.

Tom pic1The findings stated both nasal sprays cleared symptoms while asleep in about 40 per cent of cases, and those assessed by a surgeon as needing their tonsils and/or adenoids removed was reduced by half. The randomised-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.

Tonsillectomy is the most common paediatric elective surgery for children in Australia, with more than 40,000 performed each year. Commonly used to treat children’s snoring, the procedure is costly, painful and a significant burden on hospital resources.

Murdoch Children’s Dr Alice Baker said 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. Some children may also be having their tonsils and adenoids out unnecessarily, she 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,” Dr Baker said.

Snoring and breathing difficulties during sleep affect about 12 per cent of children and can cause significant long-term issues impacting cognitive function, behaviour and cardiovascular health.

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, waiting times and reduce hospital costs.” 

Stephen Graham and Emily Tuner-Graham said their son, Thomas, 7, had stopped snoring and no longer needed his tonsils removed since taking part in the trial.

Tom with mum Emily Tuner Graham pic 2

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’s such a huge relief that by just using a nasal spray, his breathing difficulties have cleared.”

The next step in the research is for Murdoch Children's researchers to explore if there are certain children who will benefit more from using the steroid spray rather than a saline spray. Recruitment is underway for the MIST+ Trial.

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Researchers from the University of Melbourne, The Royal Children’s Hospital, the Royal Hospital for Children in Glasgow, Monash Health and Monash University also contributed to the findings.

Publication: Alice Baker, Anneke Grobler, Karen Davies, Amanda Griffiths, Harriet Hiscock, Haytham Kubba, Rachel L Peters, Sarath Ranganathan, Joanne Rimmer, Elizabeth Rose, Katherine Rowe, Catherine M Simpson, Andrew Davidson, Gillian Nixon and Kirsten P Perrett. ‘Intranasal mometasone furoate for sleep-disordered breathing in children: a randomized double-blind placebo-controlled trial,’ JAMA Pediatrics. DOI: 10.1001/jamapediatrics.2022.5258

Available for interview

  • Associate Professor Kirsten Perrett, Murdoch Children’s Group Leader, Population Allergy
  • Associate Professor Gillian Nixon, Monash Children’s Hospital
  • Dr Alice Baker, Murdoch Children’s researcher
  • Stephen Graham and Emily Tuner-Graham, whose son Thomas, seven years old, took part in the trial.

Media Contact
Bridie Byrne, Media Manager
Murdoch Children’s Research Institute
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About Murdoch Children’s Research Institute
The Murdoch Children's Research Institute is the largest child health research institute in Australia committed to making discoveries and developing treatments to improve child and adolescent health in Australia and around the world. They are pioneering new treatments, trialling better vaccines and improving ways of diagnosing and helping sick babies, children and adolescents. It is one of the only research institutes in Australia to offer genetic testing to find answers for families of children with previously undiagnosed conditions.

The trial was funded by research grants awarded to A/Prof Kirsten Perrett, A/Prof Gillian Nixon and Dr Alice Baker by the Murdoch Children’s Research Institute, The Royal Children’s Hospital Foundation and the Monash Health Foundation.