Myringotomy/grommets with or without adjuvant adenoidectomy for the management of otitis media in children under 12 years will only be funded if the following criteria are met:

Otitis media with effusions (OME)

There has been a period of at least three months watchful waiting* from the date of diagnosis of OME (by GP/primary care referrer/audiologist/ENT surgeon) AND OME persists after three months AND the child suffers from persistent bilateral OME with a hearing level in the better ear of 25 dBHL (averaged at 0.5, 1, 2, and 4 kHz) or worse, confirmed over three months†.

OR

Persistent bilateral OME with a hearing level better than 25 dBHL (averaged at 0.5, 1, 2, and 4 kHz) in the better ear but where the impact of the hearing loss on a child's developmental, social, or educational status is judged to be significant†.

OR

Children who cannot undergo standard assessment of hearing thresholds where there is clinical and tympanographic evidence of persistent OME and where the impact of the hearing loss on a child's developmental, social or educational status is judged to be significant†.

*During the watchful waiting period, advice on educational and behavioural strategies to minimise the effects of hearing loss should be offered. The child's hearing should be re-tested at the end of this time.

†Good practice point: Ensure OME has not resolved once a date of surgery has been agreed, with tympanometry as a minimum.

Down's syndrome

Hearing aids should normally be offered to children with Down's syndrome and OME with hearing loss. Before myringotomy/grommets are offered as an alternative to hearing aids for treating OME in children with Down's syndrome, the following factors should be considered:

• The severity of the hearing loss
• The age of the child
• The practicality of ventilation tube insertion
• The risks associated with ventilation tubes
• The likelihood of early extrusion of ventilation tubes

Cleft palate

Insertion of ventilation tubes at primary closure of the cleft palate should be performed only after careful otological and audiological assessment. Insertion of ventilation tubes should be offered as an alternative to hearing aids in children with cleft palate who have OME and persistent hearing loss.

Adenoidectomy

Adjuvant adenoidectomy is routinely commissioned for the management of OME, even in the absence of persistent and/or frequent upper respiratory tract infections.

Recurrent acute otitis media

5 or more documented episodes of acute otitis media in the same ear in the previous 12 months

Referral Instructions

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of NHS Devon upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Email: d-icb.ifr-newsdt@nhs.net

Publication date: October 2019

Updated: May 2021