Knowledge Anglia

South Norfolk Sign In Register
  • Clinical Information
     
    • Cancer
    • Cancer - Suspected
    • Cancer - Diagnosed
    • Diagnostics
    • Haematology
    • Pathology
    • Radiology
    • Mental Health
    • Adult Mental Health
    • Antenatal and Postnatal Mental Health
    • Dementia
    • Drug & Alcohol
    • Eating Disorders
    • Gender identity / gender dysphoria
    • Learning Disabilities / Neuro Developmental Disorders
    • Severe Mental Illness (SMI) Health Checks
    • NICE
    • Connect
    • Guidelines
    • Pathways
    • Newsletters and Alerts
    • Paediatrics
    • Child Dietetics and Nutrition
    • Child ENT and Audiology
    • Child Immunisation
    • Child Learning Disabilities
    • Child Mental Health
    • Child Physical Activity and Weight Management
    • Child Respiratory
    • Child Safeguarding
    • Children over 5 & Young People
    • Children under 5 & Breastfeeding / Weaning
    • Child Prescribing
    • Other
    • Benefits, Work & Pensions
    • Cardiovascular
    • Carers and Independent Living
    • Complementary Therapy
    • Continuing Healthcare (CHC)
    • Dental
    • Dermatology
    • Diabetes & Endocrinology
    • Dietetics and Nutrition
    • End of Life and Palliative Care
    • ENT & Audiology
    • Falls
    • Fertility (Assisted Conception)
    • Gastroenterology and Colorectal
    • Genetics & Family History
    • Gynaecology, Pregnancy and Birth
    • Immunisation
    • Infection Control
    • Infectious Diseases
    • Long Term Conditions
    • Musculoskeletal & Orthopaedics
    • Nephrology
    • Neurology
    • Obesity / Weight Management
    • Ophthalmic
    • Pain Management
    • Physical Activity
    • Respiratory
    • Safeguarding
    • Screening
    • Sexual Health
    • Smoking Cessation
    • Transport
    • Travel Health and Driving
    • Urology and Urogenital
    • Veterans
  • Prescribing, Pharmacy and Medicines Optimisation
     
    • Therapeutic Advisory Group (TAG)
    • Shared Care Activity Searches
    • Shared Care Agreements
    • TAG Guidance
    • TAG Recommendations
    • TAG Update
    • Prescribing A-Z
    • A-D
    • E-H
    • I-N
    • O-S
    • T-Z
    • Clinical Areas
    • Cardiovascular
    • Chronic Pain
    • Diabetes
    • Dietetics and Nutrition
    • Respiratory
    • Care Homes
    • Commissioning Information
    • COVID-19 Prescribing / Medicines Resources
    • Drug and Safety Alerts
    • MHRA safety info for GP practices
    • MHRA safety warnings, alerts, recalls
    • NPSA Resources
    • Drug Shortages and Supply Issues
    • Forms
    • Funding Request Forms
    • Incident Reporting
    • Medicines/Prescribing
    • IFR
    • Formularies
    • Allergies
    • Analgesics
    • Antimicrobial Prescribing Guidance Summary
    • Bone
    • Cardiovascular
    • CNS - Mental Health
    • Combined Commissioned Drug Therapies List - Under Review
    • Continence including Full Guidance
    • Contraception and Gynaecology
    • Diabetes
    • Emollient Pathway
    • Eye
    • Gastrointestinal System
    • Hosiery Garment and Sundries Formulary
    • Infant Feeding
    • Nutrition
    • Pain Management Pathway
    • Respiratory - Asthma (Under review)
    • Respiratory - COPD
    • Skin
    • Urology
    • Woundcare
    • GP Practice Support
    • Norfolk and Waveney Prescriber
    • Patient Group Directions (PGDs)
    • Patient Information and Self Care
    • Policies
    • New Medicines Policy
    • PAC Policies
    • Restricted Prescribing and OTC
    • Prescribing Guidance
    • BNF / BNFC
    • BNF / BNFC - App for smartphone/tablet
    • Combined Commissioned Drug Therapies List - Under Review
    • Controlled Drugs - NICE
    • European Antibiotic Awareness Day (EAAD)
    • Key message bulletins (AGEM CSU)
    • Medicines Optimisation (NICE)
    • PrescQIPP DROP List
    • PrescQIPP Medical Devices DROP List
    • Repeat Dispensing
    • Training - Medicines Management
    • Useful Links
  • Clinical Thresholds Policy
     
    • Clinical Threshold Policy - Supporting Information
    • GP Clinical Threshold Referral
    • Individual Funding Requests: Commissioning Policy
    • Procedure Codes (May 2019)
    • A - D
    • Abdominoplasty / Apronectomy
    • Achilles Tendonopathy
    • Acupuncture
    • Arthroscopic Shoulder Decompression for Subacromial Shoulder Pain
    • Bariatric Surgery
    • Benign Skin Lesions
    • Bobath Therapy
    • Breast Surgery (Aesthetic/​Cosmetic)
    • Buttock Lift
    • Calf Implants
    • Carpal Tunnel Syndrome
    • Cataract Surgery
    • Chalazion
    • Cholecystectomy
    • Circumcision
    • Corneal Collagen Cross-Linking for Keratoconus
    • Corticosteroid Injections for Chronic hip pain
    • Cosmetic Excision of Skin of Head/​Neck
    • Cryopreservation of sperm, oocytes ​& embryos
    • Dilation and Curettage (D&C)
    • Dupuytren’s Contracture
    • Dynamic Lycra Splints
    • E - H
    • Ear Lobes - Elective repair of
    • Epiphora (treatment of)
    • Exogen Bone Healing
    • Extra-Corporeal Shockwave Therapy
    • Eyelid Ectropion
    • Eyelid Ptosis
    • Eyelid - Removal of Redundant skin
    • Facet Joint Pain (Suspected)
    • Female Genital /​ Pelvic Organ Prolapse
    • Fertility Treatment (Assisted Conception)
    • Functional Electrical Stimulation (FES)
    • Ganglion ​& Mucoid Cyst
    • Gilmores Groin (see Hernia)
    • Grommets for Adults & Children
    • Haemorrhoids
    • Hair Removal
    • Hair Replacement, Wigs
    • Hallux Valgus
    • Hernia
    • Hip Arthroplasty (Primary)
    • Hip Resurfacing
    • Homeopathy
    • Hypnotherapy
    • Hysterectomy for Heavy Menstrual Bleeding
    • I - N
    • Knee Arthroplasty (Primary)
    • Knee Arthroscopy
    • Labiaplasty
    • Laser Treatment of Myopia
    • Lipoma (surgical treatment of)
    • Liposuction
    • Liposuction for Lipodema
    • Low Back Pain - Other Procedures
    • Lymphoedema
    • Mandibular Advancement Device
    • MRI Guidance (Open/Upright and Wide-Bore)
    • Neurostimulation
    • O - S
    • Osteopathy ​& Chiropractic Therapy
    • Patella Re-Surfacing
    • Pectus Deformity - Surgery for
    • Pinnaplasty (Prominent Ears)
    • Plantar Fasciitis
    • Plastic Operations on Umbilicus
    • Radio Frequency Denervation of Facet Joints
    • Removal of Redundant Fat or Skin
    • Residential Pain Management
    • Reversal of Sterilisation
    • Rhinophyma
    • Rhinoplasty
    • Sacro-iliac injections
    • Scars ​& Keloids
    • Sensory Integration Therapy
    • Simple Snoring - Surgical Intervention
    • Spinal Fusion
    • Sterilisation by Vasectomy and Reversal
    • Steroidal Epidural Injections for Patients with Acute and Severe Sciatica
    • Surgical Discectomy (for lumbar disc prolapse)
    • T - Z
    • Thigh/Arm Contouring
    • Tonsillectomy - Recurrent Tonsillitis
    • Tonsillectomy - Sleep Apnoea (under 16)
    • Tonsillectomy - CCT with Tonsilloliths
    • Transcranial Magnetic Stimulation
    • Trigger Finger
    • Ultrasound Guided Shoulder Injections
    • Varicose Veins
    • Vertebroplasty for Osteoporosis
  • Providers / Services
     
    • Local Directory of Services
    • Add New Service
    • Acute Trusts / Hospitals
    • Addenbrookes
    • Ipswich Hospital Site (ESNFT)
    • James Paget
    • Norfolk & Norwich
    • Queen Elizabeth Hospital
    • Royal Papworth Hospital
    • West Suffolk Hospital and the Pink Book
    • Care Providers
    • Community Services
    • Email [Secure]
    • Other Services
    • CCG Website
    • Out-of-Hours
    • PCSE
    • Public Health
    • Social / Integrated Care
    • Practice Admin & Management
    • General Practice Admin & Management
    • 111 Service
    • Enhanced Services
    • e-Referral & Patient Choice
    • e-Referral Paper Switch Off - JPUH
    • e-Referral Paper Switch Off - NNUH
    • Information Governance, IT etc.
    • DA Languages (Interpreting & Translation Services)
    • NHS England General Practice
    • Quality & Patient Safety
    • Registration Authority (RA)
    • Summary Care Record
    • Social Prescribing
    • Overview - South Norfolk
    • Information for Patients
    • Patient Information Database
    • Dietetics Leaflets
    • Norfolks Living Well Leaflets
    • Patient UK
    • Patient Decision Aids
  • Forms
     
    • Cancer / 2WW
    • Norfolk & Norwich Hospital (NNUH)
    • James Paget Hospital (JPUH)
    • Queen Elizabeth Hospital (QEH)
    • West Suffolk Hospital (WSH)
    • Multi-organisation forms
    • Fertility
    • MRI
    • NOUS
    • Hearing Aid
    • Mental Health & Learning Difficulties
    • Learning Difficulty (LD)
    • Mental Health
    • Community Services
    • All Community Services
    • Children
    • Diabetes
    • End of Life
    • Exercise
    • Infectious Diseases
    • Integrated Care (ICN/ICO)
    • Neurology
    • Smoking
    • Termination of Pregnancy (ToP)
    • Weight Management
    • Continuing Healthcare (CHC)
    • Hospitals
    • Ipswich Hospital
    • James Paget Hospital
    • Norfolk & Norwich Hospital
    • Queen Elizabeth Hospital
    • West Suffolk Hospital
    • Incident reporting / Quality issue concerns
    • Individual Funding Requests
    • Medicines / Prescribing
    • Out of Hours (OOH)
    • Practice Admin
    • Services to Primary Care
    • GP Clinical Threshold Referral
    • GP Clinical Threshold Referral - RMS Participation
    • Safeguarding
    • Safeguarding Adults
    • Safeguarding Children (LSCB1)
    • Guidance
    • Referral Form Creation Guidance
    • Systmone User Guide
    • Emis User Guide
Page last updated: 27/01/2021 Home > Clinical Thresholds Policy > E - H > Grommets for Adults & Children

Grommets - Aural ventilation tube insertion (with or without adenoidectomy)

Patient Information (NHS England) - Grommets for glue ear in children patient leaflet and Grommets for glue ear in children video

 

Threshold

 

Norfolk and Waveney CCGs will fund the insertion of Grommets (aural ventilation tube) on a restricted basis for patients who meet the following criteria:

 

Children

 

Documented persistent bilateral otitis media with effusion (OME) where the following criteria are met:

  1. Watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown).

         And

  1.  Trial of ‘Otovent’ autoinflation during this 3 months period, wherever practical.

         And

  1.  a) There is hearing loss of at least 25 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz (or equivalent dBA where dBHL not available).

    Or

       b) Documented risk of speech, language or learning difficulty.

    Or

       c) Educational or behavioural problems attributable to the hearing loss.

 

Adults

 

Documented persistent otitis media with effusion (OME) where the following criteria are met:

1.      a) There has been watchful waiting for 3 months from the date of effusion onset (if known)  or 3 months from the date of diagnosis (if onset is unknown)

And

         b)  A trial of ‘Otovent’ autoinflation has taken place during this 3 months period, wherever practical

And

         c) There is hearing loss of at least 25 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz (or equivalent dBA where dBHL not available).

 OR

2.         As treatment for Meniere’s disease

OR 

3.         Severe retraction of the tympanic membrane with risk of developing cholesteatoma or erosion of the ossicular chain

 

Adjuvant Adenoidectomy – adults and children

 

Adjuvant adenoidectomy (performed at the same time as grommet insertion) will be funded only if persistent and/or frequent upper respiratory tract symptoms and consideration of the balance between benefits and harms have been documented. 

 

Exceptions: There is specific NICE guidance for adults or children with Down’s syndrome and Cleft palate as this population of patients is noted to have predisposition to otitis media with effusion. https://www.nice.org.uk/guidance/cg60

 

Management of OME in children with Down's syndrome

 

Hearing aids should normally be offered to children with Down's syndrome and OME with hearing loss.

Before ventilation tubes 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 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.

 

Management of OME in children with 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.

 

Cases for Individual Consideration

On a case to case basis, patients might be eligible for surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.

 

Latest change to document 12 March 2020
Ratification date 28 July 2020
Next Review date July 2021

Report an issue

If you find something here that is incorrect and
needs changing please tell us about it.

Give Feedback
  • Contact us
  • Submitting items for this site
  • NICE and NHS Evidence
Copyright © 2021 Knowledge Anglia. All rights reserved.