CF Guidelines - E.N.T Complications

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CF Guidelines - E.N.T Complications

Nasal Polyps:
		Occur in about 10% of children and up to 40% of adults with CF. Uncommon < 5 years and onset is generally between 8-10 years. Aetiology is uncertain but may be related to infection, allergy, immune factors, altered secretions and abnormal cilia. There is also an association with chronic sinus infection. Usually asymptomatic. Can result in chronic nasal obstruction (which increases airway resistance and may lead to mouth-breathing). Can also cause headaches and impair smell and taste. Chronic rhinitis develops which can increase the incidence of pulmonary infections. This maybe associated with secondary otitis media/hearing impairment. Annual audiology check is recommended. This may become worse after lung transplant. Diagnosis maybe made by looking up the nose with a light but sometimes it is difficult to differentiate them from inflamed turbinates.

Treatments for Nasal Polyps:
	-	Initial treatment is usually a steroid nasal spray such as fluticasone (Flixonase) or mometasone (Nasonex). The patient should be instructed to administer in the “mecca” position, and not to sniff.
	-	Steroid drops should be used if there is complete nasal blockage.
	-	Large volume saline donche (saline – rinse) used twice daily with great effect.
	-	Anti-histamines are of limited value.
	-	If unsuccessful, surgery should be considered, but due to the high recurrence rate (60-90%), multiple procedures may be necessary.
	-	Oral steroids are occasionally used for severe multiple recurrent polyps.

		If conservative treatment tails then refer to:
		-	Mr Hisham Khalil, Derriford
		-	Mr David Whinney, Truro
		-	Mr Andrew Brightwell, RD&E

Sinusitis:
		Although almost all children with CF have chronic paranasal sinusitis, only 1% are symptomatic. Plan x-ray of the sinuses is of little values, as over 92% of all children with CF will have opacification of the maxillary, ethmoid and sphenoid sinuses. Initially, opacity is due to retention of thick secretions but later it may be due to polyposis within the sinuses. The frontal sinuses rarely develop in children with CF, probably due to early onset of sinusitis, which prevents pneumatisation. CT sinuses maybe of value. Chronic sinusitis is commonly associated with nasal polyposis. It is possible to have sinusitis without nasal discharge or blockage. Sinusitis may cause headaches, particularly on tilting the head forwards. Other symptoms are related to chronic nasal obstruction (mouth-breathing, snoring, loss of sense of smell) and purulent drainage (postnasal drip, constant throat-clearing, halitosis).

Treatment for Sinusitis:
	-	Long term oral antibiotics may be of value (3-6 weeks), oral metronidazole may improve halitosis.
	-	Nasal steroid drops maybe of use.
	-	New devices to deliver aerosolided antibiotics to the sinuses have been developed (PARI) Gentamicin or Colomycin maybe used.
	-	Sinus washout is rarely successful, as the secretions are thick and tenacious; occasionally, more radical surgical drainage procedures are necessary to alleviate problems.

		Dowloadable PDF File - PDF File
				Document approved - December 2011
				Document due for review - December 2013

		Acknowledgements: The Peninsula CF team acknowledges the use of guidelines produced by The CF Trust, Manchester, Papworth, Leeds and Brompton CF teams during development of these local Peninsula protocols and guidelines.

Disclaimer: While efforts have been made to ensure that all the information published on this web site is correct, the authors take no responsibility for the accuracy of information, or for harm arising as a consequence of errors contained within this web site. If you have concerns regarding treatment, drugs or doses then consult your local CF consultant.