Seven studies (n=486) were included in the review: six RCTs (n=464) and one cohort study (n=22). Jadad score was 4 in three trials, 2 in one trial and 1 in two trials. Five studies did not describe method of randomisation and did not demonstrate adequate allocation concealment. Drug compliance was assessed adequately in one trial.
Four of the five RCTs that evaluated the effect of nasal steroids on symptoms of nasal obstruction (n=286) reported statistically significant reductions in treatment groups (range 0.97% to 50%, p<0.05) when compared to control groups. In the cohort study (n=22), which provided long-term follow up from one of the RCTs, mean symptom scores were reduced from two to zero in children who maintained therapy and were significantly increased from 1.5 to eight in those that discontinued therapy early (p<0.001).
Five RCTs evaluated the effect of nasal steroids on adenoid size (n=411), four of which reported statistically significant reductions in treatment groups (range 0.89% to 50%, p<0.05) when compared to control groups. The cohort study reported a further reduction of 20% in the adenoid to choana ratio in children who continued mometasone treatment. A 15% increase was reported in children who discontinued steroid therapy early (p=0.01).
Two trials (n=80) reported adverse events, which included epistaxis (four participants) and stinging/sneezing (seven participants); none was severe enough to necessitate withdrawal from the trials.