Operation indication for hypertrophic adenoids

Question

Dear expert team,
my daughter is 21 months old and suffers from CF. For a few weeks she has an impaired breathing through the nose and because of this especially at night after the bottle cough attacks until she has to vomit. Therefore, she had last week a flexible endoscopy at the ENT specialist. There, hypertrohic adenoids until to the choanae were diagnosed. Furthermore, she has small effusions in the middle-ear. She now receives a steriod (cortisone) nasal spray and should undergo an operation.
However, the symptoms disappeared by now totally (after the second day of cortisone nasal spray she had free nasal breathing and no cough/vomiting anymore). Therefore we ask ourselves, if it is really necessary to have the operation done and what would be the consequences if we should not have done the operation.
The ENT specialist is of the opinion, that enlarged adenoids due to the underlying disease of CF should be operated generoulsy.
I would be very thankful for your opinion, in order to discuss the topic then with our CF team.

Answer

Hello,
if the usage of cortisone nasal spray has this great success, there is actually no operation indication in my opinion.
Another presentation at the same - or probably to get a second opinion at another ENT specialist- could confirm this for sure.
The cortisone nasal spray can be used for a longer period of time, as other modern topic steroids that are metabolised in the liver quickly, even if the companies have saved the money for a license for the usage in early childhood. The dosage of cortisone is less compared to the for this age licensed steroids for bronchial inhalation, that are licensed as a long-term therapy for this age group.
We are worried in case of ENT operations, that problematic germs can be aquired in the frame of the operation or during precaution and aftercare. A
lso because of a high recurrence rate in case of real polyps in CF we are very happy, if there is no objective necessity for an operation.
I add an English article, in which we describe the aquisition of Pseudomonas in the frame of ENT operations and visits at the dentist with a case series and in which we describe preventive measures*). As said, the best prevention is to avoid a not necessary operation.
Best regards,
Dr. J. Mainz

*)Unfortunately there is no possibility to add an article; if you are interested in the mentioned article, please turn to the mail adress that you will find when clicking on "Copyright/Imprint"
Annette Pfalz for ECORN-CF

06.02.2017