Every three to five years, NHS Lancashire and South Cumbria ICB review its clinical policies to ensure they reflect the latest evidence-based guidance and best practice. We are currently reviewing the following policies and would welcome your views on the proposed changes.
Please share your feedback by completing the short questionnaire.
This policy covers surgery to treat fluid build-up in the middle ear, often involving the insertion of grommets (tiny tubes) to drain the fluid.
This revision is one that will increase provision. It includes a general statement on assessment and recognition of patients with OME and links to relevant National Institute for Health and Care Excellence (NICE) guidance (NG233, incorporating the latest evidence and guidance).
The new policy reads:
1. Surgical intervention should be given equal consideration as management of hearing loss (i.e. hearing aids).
2. Surgical management (insertion of grommets or tympanostomy tubes) is routinely commissioned if the following criteria are satisfied:-
a. In a child with 3 months of bilateral (i.e. in both ears) hearing loss
OR
b. In a child with 3 months of unilateral ie (one ear) hearing loss which is impacting on daily living or communication
OR
c. In any child with unilateral or bilateral hearing loss which is impacting on daily living or communication before the 3 months’ assessment
AND
d. In all cases (2a – 2c above), the benefits and harms of choosing either grommet surgery and hearing aids were fully discussed and a shared decision made to proceed by the clinician, child and their parents or guardians.
3. Unless contra-indicated, adenoidectomy is routinely commissioned when all of the following criteria are satisfied:-
a. The child is listed for surgical insertion of grommets
AND
b. Adenoidectomy will be performed during the grommet insertion procedure
AND
c. The benefits and harms of adjuvant adenoidectomy were fully discussed and a shared decision made to proceed by the clinician, child and their parents or guardians.
Exclusions
The following conditions are considered outside the scope of this policy and thus are excluded:_
· Suspected cholesteatoma.
· Chronic suppurative otitis media.
· Adenoidectomy performed for indications not related to OME (eg sleep apnoea, chronic rhinosinusitis, nasal obstruction, speech surgery in cleft palate).
· Retraction of ear drum without effusion.
Please note this survey closes at midnight on Friday 26 December 2025.