SRP 054 Grommets

Policy Number: SRP 054
Policy Name: Grommets
Status: Group Prior Approval / Individual Prior Approval
Effective Date: 1 April 2024
Next Review Date: 1 April 2026

Mid and South Essex ICB commissions grommet insertion on a restricted basis.

Group Prior Approval

Children

All children must have a specialist audiology and ENT assessment. Providers should ensure that glue ear has not resolved at the time of surgery using tympanometry as a minimum.

Children will be funded for grommet (ventilation tube) insertion if they meet all the following criteria:

Persistent bilateral otitis media with effusion over a period of 3 months
Hearing level in the better ear of 25-30dbHL or worse averaged at 0.5, 1, 2, & 4kHz (or equivalent dBA where dBHL not available)
*For children under 5 years of age overall hearing level applies.
OR
Children who have had at least 5 occurrences* of acute otitis media in the last year with additional complications such as perforations, persistent discharge, febrile convulsions, sensor neural deafness. *GPs should provide details of infection occurrences at the time of referral.
OR
The child has documented developmental or educational problems with persistent OME and hearing loss less severe than 25–30 dBHL in the better ear.

N.B. These criteria do not apply to patients with cochlear implants who should be referred.

The persistence of bilateral OME and hearing loss needs to be confirmed over a period of 3 months before surgical intervention will be considered. The child’s hearing should be re-tested at the end of this time. During this active observation period of 3 months, advice on educational and behavioural strategies to minimise the effects of the hearing loss should be offered.

Adjuvant adenoidectomy for the treatment of glue ear should only be offered when one or more of the following clinical criteria are met:

The child has persistent and/or frequent nasal obstruction which is contributed to by adenoidal hypertrophy (enlargement) OR
The child is undergoing surgery for re-insertion of grommets due to recurrence of previously surgically treated otitis media with effusion OR
The child is undergoing grommet surgery for treatment of recurrent acute otitis media.

Adjuvant adenoidectomy is not routinely funded in children undergoing grommet insertion for the treatment of otitis media with effusion.

Adenoidectomy-see separate policy.

Individual prior approval

Children will be considered for funding for grommets if they meet one of the following criteria and individual prior approval for funding must be obtained:

A child where there is clinical and tympanographic evidence of persistent glue ear where the impact of the hearing loss on a child’s developmental, social or educational status is judged to be significant by a specialist with expertise in child development e.g. consultant paediatrician
A child with Down’s Syndrome as an alternative to hearing aids for treating persistent bilateral OME with hearing loss and/or significant impact on child’s developmental, social or educational status as judged by a specialist with expertise in child development.
For children with Down’s syndrome, the following factors need to be considered before the intervention is offered:
– 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

Funding for children on the Cleft Lip/Palate clinical care management pathway is through NHS England Specialised Commissioning and therefore is not funded by the ICB.

Group Prior Approval

Adults

Grommet insertion is only funded for adults with disabling conductive hearing loss due to middle ear effusions, who meet the following criteria:

Retraction of the tympanic membrane, which has not responded to non-surgical intervention over a period of 3 months and if the clinician feels this may be reversible and reversing may help avoid erosion of the ossicular chain or the development of cholesteatoma.
OR
Persistent Otitis Media with effusion (OME) documented over a period of 3 months WITH a hearing level in the worst ear of 25–30 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz (or equivalent dBA where dBHL not available)
AND
Investigation and treatment of underlying causes has been completed without improvement in hearing.
OR
Unilateral hearing loss as part of postnasal space biopsy procedure, where deemed clinically necessary by the surgeon. Patients with unilateral hearing loss should be referred for review of postnasal space.

Myringotomy with or without grommet insertion is commissioned where middle ear ventilation is an essential feature of specialist investigation for management of: