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Myringotomy/grommets and adjuvant adenoidectomy for the management of otitis media in children under 12 years

Scope

This is a summary of the NHS Devon commissioning policy for Myringotomy/grommets and adjuvant adenoidectomy for the management of otitis media in children under 12 years.

Myringotomy/grommets and adjuvant adenoidectomy for the management of otitis media in children under 12 years commissioning policy

Out of scope

Children over 12 years – Myringotomy with or without ventilation tubes (grommets) in adults and children aged 12 years and older commissioning policy

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Myringotomy/grommets for the management of otitis media in children under 12 years will only be funded if the following criteria are met:

Otitis media with effusion (OME)
Persistent OME with documented hearing loss on 2 occasions assessed at intervals of 3 months or more* AND the child suffers from either (a) or (b):

a) Persistent bilateral OME with a hearing level in the better ear greater than 20 dBHL (averaged at 0.5, 1, 2, and 4 kHz), confirmed over three months†.

b) Persistent unilateral OME with a hearing level in the better ear greater than 20 dBHL (averaged at 0.5, 1, 2, and 4 kHz), confirmed over three months AND 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 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.

Recurrent acute otitis media

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

Adenoidectomy

Adenoidectomy should only be offered adjunctive to myringotomy/grommets when one or more of the following clinical criteria are met:

  • The child has persistent and / or frequent nasal obstruction which is contributed to by adenoidal hypertrophy (enlargement).
  • The child is undergoing surgery for re-insertion of grommets due to recurrence of previously surgically treated otitis media with effusion.
  • The child is undergoing grommet surgery for treatment of recurrent acute otitis media.

Guidance notes on exceptionality

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 the ICB upon receipt of a completed application from the patient’s GP, consultant, or clinician. Applications cannot be considered from patients personally.

Individual Funding Requests (IFRs) - North & East (devonformularyguidance.nhs.uk)

Individual Funding Requests (IFRs) - South & West (devonformularyguidance.nhs.uk)

Publication date: October 2019

Updated: November 2024

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