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Acupuncture and moxibustion improve adenoid to nasopharynx ratio in children with adenoid hypertrophyAcupuncture and Moxibustion May Ease Children's Adenoid Hypertrophy

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Key Takeaway
Note that acupuncture and moxibustion show clinical improvement for A/N ratio, but evidence certainty is low.

This network meta-analysis evaluated the efficacy of various acupuncture and moxibustion techniques, including conventional acupuncture, electroacupuncture, warm acupuncture, and various moxibustion types, for children with adenoid hypertrophy. The primary outcome of the adenoid/nasopharynx (A/N) ratio showed clinically relevant improvement across the interventions.

Regarding secondary outcomes, the combination of conventional moxibustion (CM) and TCMs demonstrated superior efficacy for nasal obstruction with an effect size of -1.22 (95%CI -1.82, -0.62). Other secondary outcomes included mouth breathing and snoring, though specific magnitude data for these were not reported.

The authors noted significant limitations regarding the quality of the underlying evidence. Most studies were judged as having some concerns or high risk of bias. Furthermore, the CINeMA confidence ratings for the different treatment comparisons were judged as very low to low. Clinical application should be interpreted with caution due to these low confidence ratings.

How this fits prior evidence

This network meta-analysis addresses the management of adenoid hypertrophy in children. It adds to the existing evidence regarding adenoid hypertrophy by providing data on acupuncture and moxibustion techniques. While previous evidence established that serum 25-hydroxyvitamin D levels are associated with disease severity in children with allergic rhinitis and adenoid hypertrophy, this study focuses on physical interventions for the adenoid/nasopharynx ratio and nasal obstruction.

A new analysis of existing studies suggests that acupuncture and moxibustion might help children with adenoid hypertrophy, a condition where the adenoid gland blocks nasal breathing. The review combined results from multiple trials, but the evidence is not strong enough to change practice.

The analysis looked at several techniques, including conventional acupuncture, electroacupuncture, warm acupuncture, and different types of moxibustion. The main finding was that these treatments appeared to improve the adenoid-to-nasopharynx ratio, a measure of adenoid size. One specific technique, conventional moxibustion combined with traditional Chinese medicines, showed a notable improvement in nasal obstruction compared to other treatments.

However, the researchers caution that most of the included studies had a high risk of bias, and the overall confidence in the results was very low to low. This means the findings are preliminary and not definitive. No serious side effects were reported, but safety data was incomplete.

For parents considering these options, it's important to talk to a pediatrician or an ENT specialist. This review does not prove that acupuncture or moxibustion is a reliable treatment, but it suggests that further, better-designed research might be worthwhile.

What this means for you:
Acupuncture and moxibustion may help children with adenoid hypertrophy, but evidence is weak and more research is needed.

Common questions

What is adenoid hypertrophy?

Adenoid hypertrophy is when the adenoid gland, located behind the nose, becomes enlarged. In children, this can block nasal breathing, causing mouth breathing, snoring, and sometimes sleep problems. It's a common condition in childhood.

How might acupuncture and moxibustion help?

The review found that these treatments might improve the adenoid-to-nasopharynx ratio, meaning the adenoid may shrink. One technique, conventional moxibustion with traditional Chinese medicines, showed a notable improvement in nasal obstruction. However, the evidence is weak, so these results are not conclusive.

Are there any side effects?

The review did not report any side effects, but it also did not provide complete safety data. Acupuncture and moxibustion are generally considered safe when performed by trained practitioners, but it's important to discuss risks and benefits with a doctor before trying them on a child.

Who is this treatment for?

This review focused on children with adenoid hypertrophy. It suggests that acupuncture and moxibustion might be an option, but because the evidence is weak, it's not a standard recommendation. Parents should consult a pediatrician or an ENT specialist to explore all treatment options.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
IntroductionAdenoid 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.MethodsEight 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.ResultsSeven 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 
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