Intranasal corticosteroids for nasal airway obstruction in children with moderate to severe adenoidal hypertrophy

Abstract

Background This is an update of a Cochrane Review first published in The Cochrane Library in Issue 3, 2008. Adenoidal hypertrophy is generally considered a common condition of childhood. When obstructive sleep apnoea or cardio-respiratory syndrome occurs, adenoidectomy is generally indicated. In less severe cases, non-surgical interventions may be considered, however few medical alternatives are currently available. Intranasal steroids may be used to reduce nasal airway obstruction. Objectives To assess the efficacy of intranasal corticosteroids for improving nasal airway obstruction in children with moderate to severe adenoidal hypertrophy. Search methods We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; ISI Web of Science; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 4 May 2010. Selection criteria Randomised controlled trials comparing intranasal corticosteroids with placebo, no intervention or other treatment in children aged 0 to 12 years with moderate to severe adenoidal hypertrophy. Data collection and analysis Two authors independently extracted data from the included trials and assessed trial quality. Meta-analysis was not applicable and we summarised data in a narrative format.Main results Six randomised trials involving a total of 394 patients wereincluded. Five of the six trials demonstrated a significant efficacy of intranasal corticosteroids in improving nasal obstruction symptoms and in reducing adenoid size. The first eight-week cross-over study showed that treatment with beclomethasone (336 mcg/day) yielded a greater improvement in mean symptom scores than placebo (-18.5 versus -8.5, P < 0.05) and a larger reduction in mean adenoid/choana ratio than placebo (right, -14% versus +0.4%, P = 0.002; left, -15% versus -2.0%, P = 0.0006) between week 0 and week 4. The second four-week cross-over study showed that the Nasal Obstruction Index decreased by at least 50% from baseline in 38% of patients treated with beclomethasone (400 mcg/day) between week 0 and week 2, whereas none of the patients treated with placebo had such improvement (P < 0.01). The third parallel-group trial showed that 77.7% of patients treated with mometasone (100 mcg/day) for 40 days demonstrated an improvement in nasal obstruction symptoms and a decrease in adenoid size, such that adenoidectomy could be avoided, whereas no significant improvement was observed in the placebo group. The fourth parallel-group trial showed that eight weeks of treatment with flunisolide (500 mcg/day) was associated with a larger reduction in adenoid size than isotonic saline solution (P < 0.05). The fifth parallel-group trial demonstrated that eight weeks of treatment with fluticasone (400 mcg/day) significantly reduced nasal obstruction symptoms and adenoid size, and adenoidectomy was avoided in 76% of these patients compared with 20% of the patients treated with normal saline (P < 0.05). In contrast, one parallel-group trial did not find a significant improvement in nasal obstruction symptoms nor adenoid size after eight weeks of treatment with beclomethasone (200 mcg/day).