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Topical steroids for nasal airway obstruction in children with moderately to severely enlarged adenoids

Adenoidal hypertrophy is generally considered a common condition of childhood and represents one of the most frequent indications for surgery in children. In less severe cases, non‐surgical interventions may be considered, however few medical alternatives are currently available. This review was conducted to assess the effectiveness of intranasal corticosteroids for improving nasal airway obstruction in children aged 0 to 12 years with moderate to severe adenoidal hypertrophy. Evidence derived from five of the six randomised controlled trials included in this review suggests that intranasal steroids may significantly improve symptoms of nasal obstruction in children with adenoidal hypertrophy and that this improvement may be associated with the reduction of adenoid size. One study did not find a significant improvement in nasal obstruction symptoms. Further large and high‐quality randomised controlled trials are warranted.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Lateral X-ray view of the skull for the diagnosis of adenoid hypertrophy: a systematic review

OBJECTIVES: Many studies have been developed aiming to reveal the usefulness of cavum X-rays and telerradiographies as diagnostic tools for the detection of upper airway obstruction due to adenoid hypertrophy. However, the scientific literature is diverse and controversial. Therefore, a systematic review is proposed; with the objective to determine the diagnosis value of lateral X-ray view of the skull regarding adenoid hypertrophy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review

This review assessed lateral cephalograms for diagnosing enlarged adenoids and obstructed posterior nasopharyngeal airways in children and adolescents. The authors concluded that cephalograms reliably image adenoids, but not nasopharyngeal size, and are most useful when used as a screening tool to determine the need for more rigorous follow-up. These conclusions appear likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

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

The authors concluded that nasal steroids were well tolerated and produced improvements in symptoms of nasal airway obstruction in children. This was a reasonably well-conducted review, but potential for language and publication biases and the inclusion of only a small number of good-quality trials, means that some caution is warranted when interpreting the reliability of the authors' conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

The accuracy of diagnostic tests for adenoid hypertrophy: a systematic review

BACKGROUND: Adenoid hypertrophy may cause sleep-disordered breathing and altered craniofacial growth. The authors conducted a study to gauge the accuracy of alternative tests compared with nasoendoscopy (reference standard) for screening adenoid hypertrophy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Surgical Management of Otitis Media with Effusion in Children

Otitis media with effusion (OME) is a condition characterised by a collection of fluid within the middle ear without signs of acute inflammation. It is most common in young children, with a bimodal peak at 2 and 5 years of age. Eighty percent of children will have had a least one episode of OME by the age of 10 years. At age 7–8 years, about 8% of children will have middle ear effusions; this incidence increases in winter. The mean duration of effusions is 6–10 weeks but some cases are more persistent.

NICE Clinical Guidelines - National Collaborating Centre for Women’s and Children’s Health (UK).

Version: February 2008
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Tonsillectomy for Obstructive Sleep-Disordered Breathing or Recurrent Throat Infection in Children [Internet]

To systematically review evidence addressing tonsillectomy in children with obstructive sleep-disordered breathing (OSDB) or recurrent throat infections.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: January 2017
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Adenoidectomy with or without grommets for children with otitis media: an individual patient data meta-analysis

Study found that adenoidectomy is most beneficial in children with persistent otitis media with effusion aged ≥ 4 years , with a smaller beneficial effect found in children with recurrent acute otitis media aged < 2 years, and that consideration must be given to the balance between benefits and harms.

Health Technology Assessment - NIHR Journals Library.

Version: January 2014
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Tonsillectomy with or without adenoidectomy versus no surgery for obstructive sleep‐disordered breathing in children

This review compared the benefits and harms of surgical removal of the tonsils (tonsillectomy) with or without removal of the adenoids (adenoidectomy) against non‐surgical management in children with disturbed sleep caused by breathing problems due to blockage of the upper airways (called obstructive sleep‐disordered breathing; oSDB). We included any studies in which children were randomly allocated to surgery or no surgery published up to March 2015.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions for adult Eustachian tube dysfunction: a systematic review

This systematic review found insufficient evidence to draw conclusions about the effectiveness of any intervention for adults with Eustachian tube dysfunction (ETD). The quality of the evidence was generally poor. Evidence was insufficient to allow recommendation of a trial of any particular intervention. Further research is needed to establish a definition of ETD, its relation to broader middle ear ventilation problems and clear diagnostic criteria.

Health Technology Assessment - NIHR Journals Library.

Version: July 2014
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Anti‐inflammatory drugs for the treatment of obstructive sleep apnea in children

Obstructive sleep apnea (OSA) is the partial or complete blockage of the upper airways during sleep and affects about 1% to 4% of children. The most common underlying reason for OSA in children is enlarged tonsils. Surgical removal of the enlarged tonsils is the therefore currently the treatment standard. In milder cases of OSA, treatment with anti‐inflammatory drugs to reduce the size of the tonsils is an alternative to surgery. The aim of this review was to evaluate the effectiveness of anti‐inflammatory drugs for the treatment of OSA in children between one and 16 years of age. A comprehensive literature search identified three relevant studies. Very limited evidence from these studies suggests that steroids inhaled through the nose may reduce symptoms of OSA in children. Further studies are needed to evaluate anti‐inflammatory drugs for OSA in children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children

Obstructive sleep apnoea in children is a breathing disorder characterized by episodes of partial or complete upper airway obstruction that occur during sleep. There are various risk factors and is associated with daytime and night‐time symptoms including among others sleepiness, irritability, tiredness, morning headaches, nasal stuffiness, habitual snoring, nightmares, etc. The common treatment for obstructive sleep apnoea in childhood is adeno‐tonsillectomy, the removal of the adenoids and tonsils. This approach is limited by recurrence that can be associated with craniofacial problems. Oral/functional orthopaedic appliances have been used for patients who have obstructive sleep apnoea and craniofacial anomalies because they hold the lower jaw (mandible) forwards which potentially enlarges the upper airway and increases the upper airspace, improving the respiratory function.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Montelukast for Sleep Apnea: A Review of the Clinical Effectiveness, Cost Effectiveness, and Guidelines [Internet]

Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of partial (hypopnea) or complete (apnea) upper airway obstruction during sleep despite ongoing respiratory efforts, resulting in disruption of sleep (arousal). OSA affects 9% of middle-aged men and 3% of women in North America. In children, the prevalence ranges between 1% to 5% depending on the diagnostic criteria. If left untreated, OSA can lead to fatigue, somnolence, headaches, cardiovascular disease, decreased quality of life, and increased risk of motor vehicle accidents.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 17, 2014

Gastro-Oesophageal Reflux Disease: Recognition, Diagnosis and Management in Children and Young People

This guideline focuses on symptoms of and interventions for gastro-oesophageal reflux disease (GORD). Commonly observed events, such as infant regurgitation, are covered, as well as much rarer but potentially more serious problems, such as apnoea. Where appropriate, clear recommendations are given as to when and how reassurance should be offered. In contrast, advice is given to health care professionals regarding when investigations should be considered or treatments are indicated. Finally, it is emphasised that other, and on occasion more serious, conditions that need different management can be confused with some of the relatively common manifestations of GOR or GORD. These warning signs are defined under the headings of ‘red flags’, along with recommended initial actions.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: January 2015
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