Surgical management of otitis media with effusion in children

1. Surgical management of otitis media with effusion in children Implementing NICE guidance 2008 NICE clinical guideline 60

2. What this presentation covers • What this guideline covers • Key priorities for implementation • Costs and savings • Discussion • Find out more

3. What this guideline covers • The surgical management of OME in children under 12 years. • It places a 3-month period of active observation at the centre of the care pathway. • It also provides guidance on when surgery is most appropriate. • It considers the management of OME in children with Down’s syndrome and in children with cleft palate.

4. Key priorities for implementation • Diagnosis of OME • Children who will benefit from surgical intervention • Surgical interventions • Non-surgical interventions • Management of OME in children with Down’s syndrome • Management of OME in children with cleft palate

5. Diagnosis of OME • Assessment of a child with suspected OME should include: • Clinical history taking • Clinical examination • Hearing testing • Tympanometry

6. Appropriate time for intervention • A number of cases of OME will resolve spontaneously. • A period of observation of 3 months is necessary before clinical intervention. • During this period, patients and parents/carers should be given advice on educational and behavioural strategies to minimise the effect of hearing loss. • Autoinflation may be considered during this period of observation.

7. Children who will benefit from surgical intervention Children with persistent bilateral OME over 3 months and with a hearing level in the better ear of 25–30 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz

8. Surgical interventions • Insertion of ventilation tubes is the recommended surgical intervention for OME. • After this procedure, children should be followed up and their hearing re-assessed. • Adenoidectomy is not recommended in the absence of persistent and/or frequent upper respiratory tract symptoms.

9. Non-surgical interventions • Hearing aids should be offered to children with persistent bilateral OME and hearing loss as an alternative to surgical intervention where surgery is contraindicated or not acceptable.

10. Antibiotics Antihistamines Decongestants Steroids Homeopathy Cranial osteopathy Acupuncture Dietary modification Immunostimulants Massage Non-surgical interventions (2) Not recommended

11. 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. Reproduced with kind permission of the Down's Syndrome Association

12. Management of OME in children with cleft palate • Insertion of ventilation tubes at primary closure of the palate should only be considered after careful otological and audiological assessment. • Children with persistent hearing loss should be offered ventilation tubes as an alternative to hearing aids. Reproduced with kind permission of the Cleft and Lip Palate Association

13. Costs and savings per 100,000 population

14. For discussion • How do we need to change the local care pathway for children with OME? • What is the likely impact on local audiology services? • What changes will there be in the use and costs of hearing aids? • How can we use the NICE audit for OME to improve care? • How do the issues above relate to the care of children with Down’s syndrome and children with cleft palate?

15. Find out more • Visit www.nice.org.uk/cg060 for: • Other guideline formats • Costing report and template • Audit support