International Journal of Pediatric Otorhinolaryngology
Review ArticleSystematic review and meta-analysis of randomized controlled trials on the role of mometasone in adenoid hypertrophy in children
Introduction
The adenoids are pyramid-shaped aggregation of lymphoid tissue located in the upper and posterior wall of the nasopharynx. They are present since birth and their hypertrophy is a common problem in childhood. Obstructive adenoids may cause nasal obstruction, mouth breathing, snoring, rhinorrhea, postnasal drip, cough, dry mouth, halitosis, swallowing difficulty, hyponasal voice, restlessness sleep, enuresis, and morning headache. In severe cases, they may induce obstructive sleep apnea, otitis media with effusion, and craniofacial growth abnormality [1], [2], [3]. Traditionally, adenoidal hypertrophy and its related symptoms are treated by adenoidectomy [4], though various conservative treatments to its management are under investigation. Recently, the potential role of corticosteroids, especially the topical nasal spray without any systematic side effects has been reported in adenoidal hypertrophy [5], [6]. Two systematic reviews reported some improvement in nasal obstruction with intranasal steroids in children with adenoidal hypertrophy [3], [7]. They included about seven studies of steroids, such as beclomethasone (three studies), flunisolide (one study), mometasone (two studies), and fluticasone (one study) and did not perform any meta-analysis.
Mometasone is a potent 17-heterocycylic corticosteroid and on intranasal administration, it has a higher binding to corticosteroid receptors, poor systematic concentration (0.1%), and extensive first pass metabolism. It does not suppress the hypothalamo-pituitary axis in the usual doses that are used for intranasal administration [6], [8]. Other authors [10], [11], [12], [13] and we [1], [9] found some beneficial effect of mometasone nasal spray on some outcomes of nasal obstruction induced after adenoidal hypertrophy. However, there has been no systematic review on the role of mometasone in children with adenoidal hypertrophy, though one to two studies of this topic have been explained in the previous systematic reviews of intranasal steroids [3], [7].
The objective of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the role of mometasone on symptoms of nasal obstruction, adenoid size, otitis media with effusion, and quality of life in children with adenoidal hypertrophy.
Section snippets
Materials and methods
A comprehensive search of MEDLINE, EMBASE, CINAHL and COCHRANE collaboration databases was performed. There was no restriction of publication year and the deadline of search was April 2015. Only English language articles were searched. We used the search strategy of RCTs comparing the effect of mometasone nasal spray with normal saline nasal spray or control in children with adenoidal hypertrophy on different outcomes. The search term included, adenoid or adenoids; hypertrophy, enlarged,
Results
Our search generated 87 citations and after removing the duplicates, 59 articles were retained. First level selection generated 20 articles and second level selection generated eight RCTs. The reasons of exclusion at the second level were mainly the lack of RCTs, such as observational studies (seven) [12], [13], [19], [20], [21], [22], [23], systematic reviews (two) [3], [7], subjective reviews articles (two) [24], [25], and an abstract of a published study [26] (Fig. 1). There was good
Discussion
We found significant improvements in outcomes of nasal obstruction, snoring, total nasal symptoms, pure tune audiometry, otitis media with effusion, and quality of life with mometasone and it appears to be well tolerated.
Conclusions
Mometasone caused improvements in outcomes of nasal obstruction, snoring, total nasal symptoms, pure tune audiometry and otitis media with effusion, and quality of life. The data is based on meta-analysis of poorly conducted RCTs. A high methodological quality, placebo controlled RCT of different doses and duration of administration of mometasone is required to evaluate its clear efficacy and safety in children with adenoid hypertrophy.
Funding
No.
Conflict of interests
None.
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