Efficacy of intranasal corticosteroids in improving nasal airway obstruction in children with symptomatic adenoidal hypertrophy: a meta-analysis and systematic review

Abstract

Background Adenoidal hypertrophy is considered one of the most common diseases in otolaryngology. It is usually associated with nasal obstruction symptoms like snoring and hyponasality. If not treated well, children will encounter many complications like otitis media with effusion and craniofacial abnormalities. Adenoidectomy is the main line of treatment for many otolaryngologists, but recently medical treatment by using intranasal corticosteroids (INCS) has shown beneficial effects in reducing the size of adenoids or improving the obstruction symptoms. Objectives To assess the efficacy of nasal corticosteroids in improving nasal airway obstruction in children with symptomatic adenoidal hypertrophy. Patients and Methods A comprehensive search in MEDLINE and CENTRAL was undertaken (1985–2017). We identified all randomized controlled trials in children with adenoidal hypertrophy that compared the effects of nasal corticosteroids and normal saline nasal spray on different outcomes. The primary outcomes were improvement of nasal obstruction symptoms assessed by any symptoms score and reduction in adenoid size as demonstrated by fiberoptic nasopharyngoscopy or lateral nasopharynx radiograph. Results Twenty-three relevant potential citations were identified and screened for retrieval; nine articles were suitable for these meta-analyses. The included randomized controlled trials were enrolled in five meta-analyses. Three meta-analyses showed significant improvement in adenoid size after the use of INCS with a risk ratio of 0.68, standardized mean difference (SMD)=−2.97, SMD=−0.67, respectively. Two meta-analyses showed insignificant improvement in nasal obstruction symptoms with SMD=−1.53 and SMD=0.67, respectively. Conclusion INCS can be used in children with moderate to severe adenoid hypertrophy to reduce the adenoid size and improve the associated symptoms. Close monitoring of improving of the symptoms is a must to predict the need of nonmedical management.