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Topical nasal steroids for adenoid hypertrophy in children: A systematic review and meta-analysis
Asher T Ripp1, Ethan M Kallenberger2, Shaun A Nguyen2
1Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA; SUNY Downstate College of Medicine, Brooklyn, NY, USA.
Insights
Intranasal corticosteroids (INCS) effectively treat childhood adenoid hypertrophy (AH), reducing symptoms like nasal obstruction. This meta-analysis shows INCS significantly decrease AH severity and may lower the need for adenoidectomy surgery.
Area of Science:
- Pediatric Otolaryngology
- Allergy and Immunology
Background:
- Adenoid hypertrophy (AH) is a common pediatric condition causing nasal obstruction and sleep-disordered breathing.
- Current treatments for symptomatic AH include surgery and various medical interventions with mixed results.
Purpose of the Study:
- To conduct a comprehensive meta-analysis evaluating the efficacy of intranasal corticosteroids (INCS) for treating adenoid hypertrophy in children.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Included studies evaluated INCS for pediatric AH with a control group.
- Searched Cochrane, SCOPUS, PubMed, and CINAHL databases.
Main Results:
- Analyzed 16 studies with 1156 children; 636 received INCS and 520 were controls.
- INCS significantly reduced severe AH (decrease of -43.5% vs -13.3%, p < 0.0001).
- INCS improved nasal obstruction and itching (p < 0.05) and reduced adenoidectomy rates (22.3% vs 98.6%, p < 0.0001).
Conclusions:
- Intranasal corticosteroids are effective in managing pediatric adenoid hypertrophy and associated symptoms.
- INCS improve subjective and objective measures of AH, potentially reducing the need for surgical intervention in select cases.
Objective:
Adenoid hypertrophy (AH) is a common pathology in children leading to nasal obstruction, sleep disordered breathing, and obstructive sleep apnea. Symptomatic AH is often treated surgically, and several medical interventions have been investigated with varying results. The objective of this study is to provide a comprehensive meta-analysis of the use of intranasal corticosteroids (INCS) for AH.
Data Sources:
Cochrane, SCOPUS, PubMed, CINAHL.
Review Methods:
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies of interest included those evaluating INCS for adenoid hypertrophy in children with the presence of a control group.
Results:
A total of 16 studies comprising 1156 patients were included. INCS were evaluated in 636 patients, and 520 patients served as controls. The percentage of patients with severe AH in the INCS group saw a significantly greater decrease after treatment compared to the control group (-43.5 vs -13.3, [95 % CI: 19.8-39.7 %], p < 0.0001). The INCS group also experienced greater decreases in nasal obstruction (-1.6 vs -0.6) and nasal itching (-0.7 vs -0.2) compared to the control group (both p < 0.05). The rate of adenoidectomy following medical treatment was 22.3 % in the treatment group, compared to 98.6 % in the control group (76.2 % [95 % CI: 57.0-86.6 %] p < 0.0001).
Conclusion:
INCS demonstrate efficacy in treating adenoid hypertrophy and its related sequelae in children. Improvements were noted in both subjective symptom severity and physiologic measurements of AH, indicating that INCS may reduce the need for surgery in selected patients.
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