A Cochrane review [Abstract] 1 included 5 studies with a total of 349 subjects adenoidal hypertrophy (AH). All trials except one showed significant efficacy of intranasal corticosteroids in improving nasal obstruction symptoms and in reducing adenoid size. The first 8-week study showed that treatment with beclomethasone (336 µg/day) yielded a greater improvement in mean symptom scores than placebo (-18.5 vs. -8.5, p < 0.05) and a larger reduction in mean adenoid/choana ratio than placebo (right, -14% vs. +0.4%, p=0.002; left, -15% vs. -2.0%, p=0.0006) between weeks 0 and 4. The second 4-week study demonstrated that the nasal obstruction index decreased by at least 50% from baseline in 38% of patients treated with beclomethasone (400 µg/day) between weeks 0 and 2, whereas none of the patients treated with placebo had such improvement (p<0.01). The third trial showed that 77.7% of patients treated with mometasone (100 µg/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 improvement was observed in the placebo group. The fourth trial showed that 8-weeks of treatment with flunisolide (500 µg/day) was associated with a larger reduction in adenoid size than isotonic saline solution (p<0.05). The fifth trial demonstrated that 8 weeks of treatment with fluticasone (400 µg/day) 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 randomised, parallel-group trial did not find significant improvement in nasal obstruction symptoms and adenoid size after eight weeks of treatment with beclomethasone (200 µg/day).
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies) and by limitations in study quality (lack of blinding, inadequate intention-to-treat adherence).
An RCT 2 enrolled 178 children with AH. Children were treated with intranasal flunisolide or isotonic saline solution for 8 weeks. Subsequent assessment, including history and fiberoptic endoscopy, was made at 8 weeks, and 6 and 12 months after treatment. Flunisolide treatment was initially associated with significant (p<0.01) reduction of the degree of AH. However, during follow-up all but one of the non-allergic children relapsed, whereas most allergic children maintained AH size reduction (p<0.05). In conclusion, this preliminary study demonstrates that an 8-week treatment with intranasal flunisolide is significantly associated with reduction of AH, however, the adenoidectomy avoidance was warranted only for allergic children.
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