Glue ear surgery in Scottish children 1990-1994: still plenty of ENT and Public Health challenges!

Abstract

This paper examines recent trends in glue ear surgery in Scottish children between 1990 and 1994, using routine National Health Service (NHS) data from all 15 Scottish Health Boards (total population 5,132,400 in 1994, with 1,038,296 aged 0-15). Absolute numbers, rates of glue ear operations, and variation in rates declined between 1990 and 1994 across all Health Boards. The proportion of glue ear operations which included grommet insertion increased. Grommet rates in children declined in those Boards with the highest rates, but increased in Boards with the lowest rates, thereby decreasing the variation in grommet rates across Scottish Health Boards from 3.8- in 1990 to 2.6-fold in 1994. Other operations for glue ear, particularly 'myringotomy and adenoidectomy', varied 20-fold between Health Boards. The proportion of operations performed as day cases increased, but day cases and repeat grommet insertions still showed two-fold variation across Scotland in 1994. Many aspects of surgical management still show variation, and merit further examination by ENT surgeons and Public Health physicians.

Otitis media surgery: Large variability between Finland and Norway

“…The main purpose of middle ear drainage is aeration and improved hearing. The extent of improved hearing on development of speech, language, cognition and social behaviour is not easily gauged [26]. Additionally, parental demand for quick illness recovery in children may influence the decision-making process and timing for surgery, as demonstrated by Kvaerner et al [27].…”

“…End-points of treatment for otitis media are particularly difficult to identify [26]. The main purpose of middle ear drainage is aeration and improved hearing.…”

Paediatric otitis media surgery in Norway

“…Few complete national reports on surgery for otitis media have been published [4,15]. According to Bisset, ventilation tubes in Scotland in 1994 were inserted at a rate of 27.4 in children aged 0Á15 years; the rates for myringotomy, and combinations adenoidectomy and tympanostomy tubes and adenoidectomy and myringotomy were 5.2,14.5 and 9.5, respectively [15]. Scotland is comparable to Norway in population size and childhood population.…”

“…Further, clinical trials are usually based on protocol designs that may not represent the clinical practice of the country [14]. Few complete national reports on surgery for otitis media have been published [4,15]. According to Bisset, ventilation tubes in Scotland in 1994 were inserted at a rate of 27.4 in children aged 0Á15 years; the rates for myringotomy, and combinations adenoidectomy and tympanostomy tubes and adenoidectomy and myringotomy were 5.2,14.5 and 9.5, respectively [15].…”

Surgery for otitis media and infectious susceptibility in 10-year old school children

“…Operative treatment has a long tradition and involves myringotomy, adenoidectomy and insertion of tympanostomy tubes [4]. Outcome of operative intervention is difficult to gauge but research on otitis media surgery targets improved hearing, language and cognitive skills [5][6][7]. There are few long-term reports on susceptibility for otitis media in previously operated children [8].…”