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

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

         And

3.  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.