Download Grommet insertion in children

Policy Category:
CBA&PA
Who usually applies for funding?
Consultant
Grommet Insertion in Children
Commissioning
decision
The CCG will provide funding for grommet insertion in children
under the age of 12 years old who meet the criteria defined within
this policy. Funding approval for eligible patients must be sought
from the CCG via the Prior Approval process prior to treatment.
Policy Statement:
Funded for recurrent otitis media with effusion (OME) for children under the age of 12 years
when there has been:



confirmed diagnosis of OME followed by two visits to Audiology at least 3 months
apart from the date of the first appointment with the GP and then referral for surgery
PLUS EITHER
diagnosis of persistent bilateral OME with a hearing level in the better ear of 25-30
dBHL or worse
OR
diagnosis of persistent bilateral OME with a hearing level of less than 25-30 dBHL
which is having a significant impact on the child’s developmental, social or
educational status
Adjuvant adenoidectomy is not recommended in the absence of persistent and/or frequent
upper respiratory tract infections.
Rationale:
Surgical management is funded in line with NICE Clinical Guidance on Surgical
management of otitis media with effusion in children (CG60).
Plain English Summary:
Otitis media with effusion (OME) is defined as inflammation of the middle ear, accompanied
by the accumulation of fluid in the middle-ear cleft, without the symptoms and signs of acute
inflammation. It often results in hearing loss and is the most common cause of hearing loss
and elective surgery in childhood.
The use of surgical treatment for OME has fallen dramatically in recent years with the
recognition that many cases resolve with active observation. NICE (the National Institute for
Health and Care Excellence) recommends that children who most benefit from surgery are
those with persistent bilateral OME lasting three or more months with a hearing level in the
better ear of 25-30 dB HL. Children with better hearing but who have social, educational or
developmental difficulties may exceptionally also benefit from surgical treatment.
Insertion of grommets (ventilation tubes) is the first-line treatment. Adenoidectomy is only
recommended if recurrent upper respiratory tract symptoms are a feature. Insertion of
grommets results in an improvement in hearing over a twelve-month period which starts to
tail off after six months. There is little evidence that language or speech development
improves in the long term.
If your child is suffering with otitis media with effusion your doctor will need to assess
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Policy Category:
CBA&PA
Who usually applies for funding?
Consultant
whether he/she is likely to benefit significantly from surgery, based on the criteria set out in
the policy. If your doctor believes that your child meet the criteria set out in this policy they
can submit a Prior Approval application to the CCG in order to seek funding approval for
your surgery. The CCG will review your case and if we agree that the criteria have been met
we will authorise funding.
Evidence base:
NICE Guidance - Surgical management of otitis media with effusion in children (CG60)
February 2008 - (on static list)
Cochrane Library - http://ent.cochrane.org/guidelines Otitis Media With Effusion:
Comparative Effectiveness of Treatments.
Similarity to policies in other local CCGs – Bristol, South Gloucestershire, Bath and North
East Somerset, West Midlands, Oxfordshire.
Link to application form – Prior Approval Application Form
For further information please contact [email protected]
Date of publication
Policy review date
1st August 2015
8th November 2018
Consultation
Consultee
Planned Care Programme Board
CCG Governing Body Development Session
GHNHSFT (via General Manager/Head of Contracts)
GP Membership (via CCG Live/What’s New This Week)
Date
31st March 2015 (virtual)
4th June 2015
18/05/2015 – 29/05/2015
06/05/2015 – 05/06/2015
Has the consultation included patient representatives?
No
Policy sign off
Reviewing Body
Effective Clinical Commissioning Policy Group
Integrated Governance and Quality Committee
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Date of review
8th November 2016
18th June 2015