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Procedure’s of limited clinical value?

Procedure’s of limited clinical value?. Several PCT’s have lists NHS Bradford and Airedale doesn't ENT related conditions that are included are: Tonsillectomy and adenoidectomy Grommets snoring. Tonsillectomy. SIGN guidance 2010 HSJ report 2010 Cochrane 2009.

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Procedure’s of limited clinical value?

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  1. Procedure’s of limited clinical value?

  2. Several PCT’s have lists • NHS Bradford and Airedale doesn't • ENT related conditions that are included are: • Tonsillectomy and adenoidectomy • Grommets • snoring

  3. Tonsillectomy • SIGN guidance 2010 • HSJ report 2010 • Cochrane 2009

  4. Sore throats are due to tonsillitis • Episodes are disabling and prevent normal functioning (missing work or school etc) • 7 or more well documented, clinically significant sore throats in the preceding year • 5 or more such episodes in each of the preceding 2 years • 3 or more such episodes in each of the preceding 3 years • Is frequency decreasing or increasing? • HSJ report – increased admissions over last few years

  5. Grommets • NICE guidance 2008 and 2000 • Cochrane review 2005

  6. Background • >50 % glue ear resolves by 3/12 • >80% resolves at 9/12 • Grommets improving hearing on a PTA • Little long term evidence that they effect development • Varying impact of glue ear on each individual

  7. NICE 2008 • Hearing assessment • Watch and wait • Reassess at 3 months • Consider Grommets if persistent hearing loss >25dB in the worse ear

  8. Management in primary care • Clinical history and examination • Tympanogram and PTA • School nurse

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