Myringotomy with and without grommets in adults and children aged 12 years+

Referral Criteria

Myringotomy with or without ventilation tubes (grommets) will only be funded if the following criteria are met:

Persistent otitis media with effusion (OME) – There has been a period of at least three months watchful waiting* from the date of diagnosis of OME (by GP/primary care referrer/audiologist/ENT surgeon) and OME persists after three months andthe patient suffers from persistent bilateral OME with a hearing level in the better ear of 25 dBHL (averaged at 0.5, 1, 2, and 4 kHz) or worse, confirmed at three months†.

Or

To aid intratympanic administration of medicines

Or

Where middle ear ventilation is an essential feature of specialist investigation for, or management of:

• underlying malignancy
• acute or chronic otitis media with complications: facial palsy or intracranial infection e.g. meningitis

*During the watchful waiting period, advice on lifestyle modifications such as stopping smoking (and if appropriate advice on educational and behavioural strategies to minimise the effects of hearing loss) should be offered. The patient's hearing should be re-tested at the end of this time.

†Good practice point: ensure OME has not resolved once a date of surgery has been agreed, with tympanometry as a minimum

Referral Instructions

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of NHS Devon upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Applications for consideration for funding approval should be sent to:

Email: d-icb.ifr-newsdt@nhs.net

Publication date: 28 October 2019