Intranasal Steroids for Adenoidal Nasal Obstruction

Abstract

Objective 1) To systematically review the evidence for intranasal steroids in the treatment of nasal obstruction caused by adenoidal hypertrophy, in children. 2) To determine the risk of adverse events of treatment. Methods We performed a systematic review and metaanalysis following a specified protocol. Databases searched (May 2007) included Cochrane CENTRAL, MEDLINE, EM-BASE, CINAHL, AMED, LILACS, KoreaMed, IndMED, SIGLE, Cambridge Scientific Abstracts, mRCT, National Research Register, ISRCTN, and ISI Web of Science. Results 56 studies were identified, with 4 randomized controlled trials (RCTs) meeting the inclusion criteria. Trial 1: an 8-week crossover RCT demonstrating 4-weeks beclomethasone (336 mcg/day) showed a 45% reduction in symptom scores (p<0.01). Trial 2: a 4-week crossover RCT demonstrating a reduction in nasal obstruction index by 50% in patients treated with beclomethasone (400 micrograms/day) for 2 weeks (p<0.0001). Trial 3: a 40-day parallel RCT which showed that 77.7% of patients treated with mometasone (100 micrograms/day) demonstrated an improvement in nasal obstruction symptoMS Trial 4: an 8-week parallel RCT demonstrated no significant improvement in nasal obstruction symptoms after 8-weeks treatment with beclomethasone (200 micrograms/day). Low statistical power and low dose of beclomethasone may have contributed to this negative result. Conclusions Current evidence suggests that intranasal corticosteroids may significantly improve nasal obstruction symptoms in children with adenoidal hypertrophy, and this improvement was associated with a reduction of adenoid size. Given the safety and tolerability of intranasal corticosteroids, it seems reasonable to recommend the use of these drugs as an effective treatment for children with adenoidal hypertrophy when adenoidectomy is not urgently required.