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Tonsils and adenoids

Dear doctor,

Should the tonsils and adenoids be removed in a child with CF? Is there an increased risk of complications or loss of immunity? We would like your opinion on the need to remove or not remove tonsils and adenoids in a child with CF with little nose throat complaints.
Dear questioner,

I will first answer this question in general and then more geared towards cystic fibrosis.

Tonsils and adenoids are part of our immune system. They consist of lymphoid tissue. In young children with frequent upper airway infections, this lymphoid tissue can proliferate and obstruct the upper airway. These children will then have a blocked nose, snoring and may have protracted cough. Fluid may accumulate behind the eardrums and this can cause hearing problems. Snoring can lead to poor sleep quality with fatigue during the day, poor appetite and learning difficulties. The decision to remove the adenoids or tonsils will thus depend on the severity and type of symptoms that the child has. Removing the adenoids is a rather small intervention done during a short general anaesthesia. Afterwards children will have improved quality of sleep, less snoring, less cough, better hearing and approved appetite. Removing the tonsils is more painful. This is only indicated when the tonsils are really that large that they touch the in the midline, when there are repeated Streptococcal throat infections or when there is obstructive sleep apnoea. Not in all children adenoids and tonsils should be removed at the same time.

Also in a child with CF, it needs to be evaluated to what degree enlargement of the adenoids and tonsils leads to symptoms. Toddlers with CF will have frequent upper airway infections, they can have enlarged tonsils and adenoids, but they can also have nasal polyps that protrude in the nasal passages. These nasal polyps are typical for CF. Examination by the ear-nose-throat doctor can reveal whether it concerns adenoids or nasal polyps. Sometimes a CT scan will bring more information.
We can only give general information in ECORN. Of course whether your child needs surgery, should be discussed with your doctor and E-N-T surgeon.

Best regards,

Prof. dr. M. Proesmans