Using nasal steroids to treat nasal obstruction caused by adenoid hypertrophy: Does it work?

Abstract

OBJECTIVE: To systematically review the evidence for the usage of nasal steroids to improve symptoms of nasal airway obstruction in children with adenoidal hypertrophy. DATA SOURCES: Published studies indexed in the MEDLINE (1951 to 2008), EMBASE (1974 to 2008), and the Cochrane databases (Issue 3, 2008). REVIEW METHODS: Data from the included trials were ex- tracted and trial quality was assessed. Meta-analysis was not ap- plicable and data were summarized in a narrative format. Evidence from excluded studies was also discussed. RESULTS: Seven studies (six randomized controlled trials and one cohort study) met the inclusion criteria of the review, includ- ing a total of 493 patients. Six of these studies demonstrated significant efficacy of various nasal steroids (mometasone, be- clomethasone, flunisolide) in improving nasal obstruction symp- toms and in reducing adenoid size, as measured with symptom scores and fiber-optic nasopharyngeal endoscopy, respectively. The response appeared to be a group effect and may be maintained longer-term by continuing nasal steroids at a lower maintenance dose. The treatment was safe and well-tolerated with few minor adverse events. CONCLUSION: The available evidence suggests that nasal ste- roids may significantly improve nasal obstruction symptoms in children with adenoid hypertrophy. This improvement appears to be associated with a reduction of adenoid size. Evidence of long- term efficacy is limited but suggests that in many children main- tenance therapy is needed if symptom-relief is to persist. Further studies are required to support the use of nasal steroids as a first-line approach in these children.