Surgical management of otitis media with effusion in

Surgical management of otitis media with effusion in children: A rolling audit in the ENT Unit in XXXX

Objective �To evaluate how well we are adhering to national guidelines (CG 60: Surgical management of OME, Feb 2008); specifically do our paediatric patients meet the criteria for surgery

Local guidelines adapted from National NICE guideline �In cases of OME 1. ≥ 3/12 of watchful waiting 2. ≥ 25 db of conductive hearing loss in better ear 3. Alternatives to surgery discussed �In cases of recurrent AOM 1. ≥ 4 episodes in 6 months 2. Alternatives to surgery discussed

Methods �Retrospective review of the clinical notes at pre-admission by SHOs conducted from 20/09/2013 to 10/01/2013. �Pre-existing proforma listing the NICE criteria completed for each child listed for bilateral insertion of grommets for bilateral OME. �Completed forms then reviewed by ER and checked against clinical letters on clinical portal and adherence and non adherence recorded with details of latter cases obtained.

Results (1) • In ~3/12 there were 21 cases of children having bilateral insertion of grommets Indications for bilateral grommet insertion 9% 6% 14% 71% OME (15/21) Recurrent AOM (3/21) Both (2/21) Other (1/21)

Results 2 Compliance of ENT unit with National guidelines: CG 60 5% 10% 5% Adherence (17/21) Non-adherence (1/21) Mitigating circumstances (2/21) Not documented (1/21) 81%

Results 3 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Breakdown of individual clinician adherence to guidelines Adherence 0 0 0 1 2 0 9 1 3 5 SURG 1 SURG 2 Non-adherence SURG 3 SURG 4 Mitigating circumstances 0 SURG 5 Not documented

Results (4) � 1 case of non adherence: Patient reported 6/12 hx of hearing loss and had a bilateral conductive hearing loss on audiometry and was listed for surgery on that first OPC appt; No 3/12 of watchful waiting. (? discussion of surg) � 1 st case with mitigating circumstances: Patient presented with a history of poor language development. No 3/12 of watchful waiting or formal audiometry. � 2 nd case with mitigating circumstances: Patient had normal audiogram, but family history of mastoiditis, recurrent episodes of AOM (not quantified)

Conclusions �Low incidence of non adherence to guidelines (~5%) �Would completing existing proforma at time of listing patients help improve this or needlessly generate more paper-work in what are already busy clinics? �Observations made during audit: �Documentation of discussion regarding alternatives to surgery not always clear. �Quantification of cases of AOM often not stated.