Traditional Chinese medicine for pediatric adenoid hypertrophy: an Umbrella review of methodological, reporting, and evidence quality.

OBJECTIVE: To conduct an umbrella review evaluating the methodological quality, reporting completeness, and certainty of evidence from systematic reviews and meta-analyses on traditional Chinese medicine (TCM) for pediatric adenoid hypertrophy (AH). METHODS: A systematic search was conducted in PubMed, Web of Science, CNKI, VIP, and Wanfang databases from inception to March 2026, with no language restrictions. Eligible systematic reviews and meta-analyses of randomized controlled trials (RCTs) on TCM for pediatric AH were included. Two reviewers independently performed screening, data extraction, and quality assessment using AMSTAR-2, PRISMA 2020, and GRADE. Discrepancies were resolved by consulting a third reviewer. RESULTS: Ten systematic reviews and meta-analyses encompassing 122 RCTs and 9,772 participants were included. All included reviews were rated as having low or critically low methodological quality and inconsistent reporting standards. Existing reviews reported possible improvements in clinical symptoms and adenoid-related outcomes with TCM interventions. However, these findings should be interpreted cautiously because of methodological limitations, risk of bias in the underlying trials, publication bias, imprecision, and clinical heterogeneity. CONCLUSION: Current review-level evidence on TCM interventions for pediatric AH remains methodologically weak and uncertain. The included systematic reviews showed low or critically low methodological quality, incomplete reporting, and limitations in the certainty of evidence. Future studies should prioritize well-designed randomized controlled trials, standardized outcome reporting, and rigorously conducted systematic reviews.