Throat, nose and adenoids

Question

Is it important that a toddler with CF should have his tonsils and adenoids removed? The only complaint is noisy breathing during the day and snoring at night time. I read that the tonsils are important to prevent bacterial infections. Should the tonsils and adenoids in children with CF be removed or not?
A father.

Answer

Dear questioner
Thank you for your interest in the ECORN medium.
Children with CF can have the same health problems as children who do not suffer from CF.
Adenoids are located in the back of the nasal cavity just above the soft palate. They consist of lymphoid tissue. As a result of repeated upper airway infections their volume can increase. The adenoids can become so large that breathing via the nose becomes impossible. These children will thus open their mouth, snore at night, have poor sleep quality and have repeated upper airway infections that linger on for weeks. The continuing mouth breathing will also deform the dental arch. The Eustachian tube, a connection between the nasal cavity and the middle ear, will also become dysfunctional. Recurrent rhinitis and accumulation of the fluid behind the ear drums can cause diminished hearing. All these problems are also seen in healthy toddlers and spontaneous improvement is to be expected. When severe and protracted symptoms occur, removal of the adenoids can offer a solution. There is no sign that this treatment has any negative influence on the immunity in children. Complications of the surgery rarely occur. The surgery is done under general anesthesia and is moderately painful. Mild bleeding after the surgery can occur.
Tonsils also consist of lymphoid tissue and they are located on both sides in the throat cavity. In some children they can become chronically infected. Symptoms such as repeated tonsillitis with sore throat, fever, diminished appetite and foul breath can occur. The tonsils can become so large that they cause trouble: difficulty swallowing, narrowing the airway with snoring and poor sleep quality. The tonsils can be removed surgically if again the symptoms are protracted or severe. This surgery is much more painful than taking away the adenoids and the same risk of bleeding in the postop period exists.
There is no indication that patients with CF will profit more or less from removal of tonsils and adenoids compared to other children. This surgery is only needed when severe or protracted problems as described above occur.
The above mentioned surgery needs to be done under general anesthesia. In patients with CF it is important that this is done at a time that lung infection is well controlled and under the cover of antibiotic therapy. Extra attention to thorough chest physiotherapy before and after the surgery is also needed.

The following is however specific to CF.
Patients with CF can suffer from chronic sinusitis and can develop nasal polyps. These can also cause nasal obstruction, rhinitis and foul breath. The doctor should carefully examine what the cause of the complaint is. Nasal polyps are typical for patients with CF and they’re rarely seen in healthy people. At times a CT scan of the sinus or an endoscopic examination of the nasal cavity (with a thin fiberoptic scope) can help. The advice of a ear-nose-throat doctor with experience in the follow-up and treatment of patients with CF is important.
In conclusion: patients with CF have the same risk of having hypertrophy of the tonsils or adenoids compared to other children. Surgery is only needed in the case of severe and protracted symptoms. Differential diagnosis with nasal polyps should be done. If surgery is needed, it should be done at a time when lung infection is well controlled, under cover of antibiotics and with careful pre- and postoperative follow-up.
Prof. Kris De Boeck

03.05.2012