Non-pharmacological therapy for pediatric adenoid hypertrophy: a systematic review and network meta-analysis.

INTRODUCTION: Adenoid hypertrophy (AH) is a common chronic inflammatory condition in children and a major cause of upper airway obstruction. Although acupuncture- and moxibustion-based therapies have been used as adjunctive treatments for pediatric AH, the relative efficacy of different modalities remains uncertain. Therefore, this network meta-analysis was conducted to compare the efficacy of different acupuncture and moxibustion interventions for pediatric AH. METHODS: Eight databases were searched from their inception to May 1, 2025, for randomized controlled trials (RCTs) related to acupuncture for AH. The risk of bias was assessed using the Cochrane Risk of Bias (RoB 2.0) tool. Network meta-analysis was conducted using R 4.2.0 and Stata 14.0 software. RESULTS: Seven kinds of acupuncture and moxibustion adjuvant intervention measures were studied, including conventional acupuncture (CA), electroacupuncture (EA), warm acupuncture (WA), conventional moxibustion (CM), thunder-fire moxibustion (TM), sandwiched moxibustion (SM), and acupoint application (AA). Adenoid/nasopharynx ratio (A/N), nasal obstruction, mouth breathing, and snore were analyzed. RoB2.0 results showed most studies were judged as having some concerns or high risk of bias, and sensitivity analysis showed low heterogeneity. CINeMA showed the confidence ratings of different treatment comparisons were judged as very low to low. The network meta-analysis demonstrated that CA + TCMs (traditional Chinese medicine) showed a clinically relevant improvement in the A/N ratio. CM + TCMs exhibited superior efficacy for nasal obstruction [MD = -1.22, 95%CI(-1.82, -0.62), P < 0.05] and mouth breathing [MD = -1.04, 95%CI(-1.43, -0.65), P < 0.05]. CA + EA + WA demonstrated advantage for snore reduction [MD = -1.00, 95%CI(-1.70, -0.30), P < 0.05]. CONCLUSION: Acupuncture- and moxibustion-based adjunctive therapies may be associated with improvements in symptoms and radiological outcomes in pediatric adenoid hypertrophy. However, the certainty of the evidence ranged from very low to low, and these findings should be interpreted cautiously. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/home, identifier CRD420251052651.