Reviewed on : 11 Sep 2024

Reviewed by : Lucy Dyde, IFR Team Manager CWICB

Expires : 11 Sep 2026

Grommets / Myringotomy for adults

1. Category: Prior Approval

Prior approval from the Integrated Care Board (ICB) will be required before any treatment proceeds in secondary care unless an alternative contract arrangement has been agreed with the ICB that does not necessitate the requirement of prior approval before treatment.

2. Indication

Otitis media with effusion (OME)

3. Eligibility Criteria

Surgical treatment for adults to be supported subject to policy criteria

Myringotomy With/Without Grommets for Otitis Media will ONLY be funded for adults meeting at least one of the following criteria:

• Persistent hearing loss for at least 3 months with hearing levels of 25dB or worse on pure tone audiometry OR
• Recurrent acute otitis media – 4 or more episodes in a 12 month period or 3 or more in 6 months OR
• Eustachian tube dysfunction causing pain OR
• Atelectasis of the tympanic membrane where development of cholesteatoma or erosion of the ossicles is a risk OR
• As a conduit for drug delivery direct to the middle ear OR
• In the case of conditions (e.g. nasopharyngeal carcinoma, ethmoidal cancer, maxillectomy, olfactory neuroblastoma, sinonasal cancer and complications relating to its treatment (including radiotherapy)) if judged that the benefit/s of treatment outweigh the risk/s by the responsible clinician OR
• Part of a more extensive procedure at consultant’s discretion, such as tympanoplasty, acute otitis media with facial palsy

For patients who DO NOT meet the eligibility criteria, the ICB will only consider funding the treatment if an Individual Funding Request (IFR) detailing the patient’s clinical presentation is submitted to the ICB

4. Guidance/References

https://pubmed.ncbi.nlm.nih.gov/36939424/

https://pubmed.ncbi.nlm.nih.gov/36742680/

NHS Coventry and Warwickshire Integrated Care Board Page 4 of 18 Policy for Grommets/Myringotomy for Adults, September 2024, V2, Review Date: March 2027

60. Maw R, Bawden R. Spontaneous resolution of severe chronic glue ear in children and the effect of adenoidectomy, tonsillectomy, and insertion of ventilation tubes (grommets) BMJ. 1993;306(6880):756–760. doi: 10.1136/bmj.306.6880.756

Lau L, Mick P, Nunez DA. WITHDRAWN: Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database Syst Rev. 2018 Apr 6;4(4):CD004741. doi: 10.1002/14651858.CD004741.pub3. PMID: 29624209; PMCID: PMC6494442.

https://gpnotebook.com/simplepage.cfm?ID=x20210514135227433766&linkID=81725

Venekamp, RP, Mick, P, Schilder, AG, Nunez, DA. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database Syst Rev 2018;(5):CD012017CrossRefGoogle ScholarPubMed

Cheong, KH, Hussain, SSM. Management of recurrent acute otitis media in children: systematic review of the effect of different interventions on otitis media recurrence, recurrence frequency and total recurrence time. J Laryngol Otol 2012;126:874–85CrossRefGoogle ScholarPubMed

NHS Coventry and Warwickshire Integrated Care Board Page 5 of 18 Policy for Grommets/Myringotomy for Adults, September 2024, V2, Review Date: March 2027