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preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng233er13-lrg.png" alt="Cover of Evidence reviews for follow-up strategy after surgical treatment for OME-related hearing loss" /></a></div><div class="bkr_bib"><h1 id="_NBK595323_"><span itemprop="name">Evidence reviews for follow-up strategy after surgical treatment for OME-related hearing loss</span></h1><div class="subtitle">Otitis media with effusion in under 12s</div><p><b>Evidence review M</b></p><p><i>NICE Guideline, No. 233</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2023 Aug</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-5343-1</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2023.</div></div><div class="bkr_clear"></div></div><div id="niceng233er13.s1"><h2 id="_niceng233er13_s1_">Follow-up strategy after surgical treatment for OME-related hearing loss</h2><div id="niceng233er13.s1.1"><h3>Review question</h3><p>What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</p><div id="niceng233er13.s1.1.1"><h4>Introduction</h4><p>The aim of this review is to investigate follow-up strategies after surgical treatment for OME-related hearing loss in children under 12 years.</p><p>At the time of development, the term ventilation tube (VT) was used to refer to tubes inserted during surgery for OME. However, the committee agreed that the term grommet should be used as this is likely to be the term that is more familiar to readers of the guideline and would avoid confusion with tubes used to assist with breathing. Therefore, both terms appear in this evidence review.</p></div><div id="niceng233er13.s1.1.2"><h4>Summary of the protocol</h4><p>See <a class="figpopup" href="/books/NBK595323/table/niceng233er13.tab1/?report=objectonly" target="object" rid-figpopup="figniceng233er13tab1" rid-ob="figobniceng233er13tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng233er13tab1"><a href="/books/NBK595323/table/niceng233er13.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng233er13tab1" rid-ob="figobniceng233er13tab1"><img class="small-thumb" src="/books/NBK595323/table/niceng233er13.tab1/?report=thumb" src-large="/books/NBK595323/table/niceng233er13.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICO table)." /></a><div class="icnblk_cntnt"><h4 id="niceng233er13.tab1"><a href="/books/NBK595323/table/niceng233er13.tab1/?report=objectonly" target="object" rid-ob="figobniceng233er13tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO table). </p></div></div><p>For further details see the review protocol in <a href="#niceng233er13.appa">appendix A</a>.</p></div><div id="niceng233er13.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng233er13.appa">appendix A</a> and the methods document (<a href="/books/NBK595323/bin/NG233_supplement_1_Methods_20230830.pdf">supplementary document 1</a>).</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng233er13.s1.1.4"><h4>Effectiveness evidence</h4><div id="niceng233er13.s1.1.4.1"><h5>Included studies</h5><p>A systematic review of the literature was conducted but no studies were identified which were applicable to this review question.</p><p>See the literature search strategy in <a href="#niceng233er13.appb">appendix B</a> and study selection flow chart in <a href="#niceng233er13.appc">appendix C</a>.</p></div><div id="niceng233er13.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng233er13.appj">appendix J</a>.</p></div></div><div id="niceng233er13.s1.1.5"><h4>Summary of included studies</h4><p>No studies were identified which were applicable to this review question (and so there are no evidence tables in <a href="#niceng233er13.appd">Appendix D</a>). No meta-analysis was conducted for this review (and so there are no forest plots in <a href="#niceng233er13.appe">Appendix E</a>).</p></div><div id="niceng233er13.s1.1.6"><h4>Summary of the evidence</h4><p>No studies were identified which were applicable to this review question (and so there are no GRADE tables in <a href="#niceng233er13.appf">Appendix F</a>).</p></div><div id="niceng233er13.s1.1.7"><h4>Economic evidence</h4><div id="niceng233er13.s1.1.7.1"><h5>Included studies</h5><p>A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.</p></div></div><div id="niceng233er13.s1.1.8"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation especially as it was anticipated that there would be little if any effective evidence on which to underpin an analysis.</p></div><div id="niceng233er13.s1.1.9"><h4>The committee's discussion and interpretation of the evidence</h4><div id="niceng233er13.s1.1.9.1"><h5>The outcomes that matter most</h5><p>Hearing loss or hearing difficulty is often associated with OME, and this could impact on the child’s language and behavioural development. Effective follow-up strategy after surgical treatment for OME-related hearing loss may improve hearing and may reduce the need for additional intervention (for example, repeat ventilation tube insertion and antibiotics) by identifying potential issues earlier. Therefore, hearing and additional intervention were prioritised as critical outcomes. The committee agreed that parent, carer and child satisfaction is an important dimension of quality of care and may be impacted by different follow-up strategies; therefore, it was also prioritised as a critical outcome.</p><p>Otorrhoea is a common complication after surgery, which may both recur and lead to poor quality of life in children with OME. The committee agreed that this may be impacted by differences in follow-up as it may be identified and treated earlier if children are followed up more regularly. Therefore, persistent otorrhoea was selected as an important outcome. Similarly, perforation of the tympanic membrane was also selected as an important outcome because differences in follow-up may lead to differences in the identification and treatment of factors that may cause perforation, such as infection. In addition, quality of life was selected as an important outcome as this is a global measure that takes into account both beneficial and adverse effects of the interventions.</p></div><div id="niceng233er13.s1.1.9.2"><h5>The quality of the evidence</h5><p>No studies were identified which were applicable to this review question.</p></div><div id="niceng233er13.s1.1.9.3"><h5>Benefits and harms</h5><p>There was no available evidence on the effectiveness of the follow-up strategy after surgical treatment for OME-related hearing loss in children under 12 years. Therefore, the committee made recommendations based on current practice and their knowledge and experience.</p><p>The committee acknowledged that it is important for medico-legal reasons to detect complications of surgery as soon as possible, particularly hearing loss, to provide necessary treatment and avoid its harmful impacts. The committee were aware that post-operative hearing tests tend to be performed 6 weeks after surgery, which should allow sufficient time for post-operative bleeding to resolve. This may also give the opportunity to check if grommets have fallen out early which can happen, for example, if the hole made for the grommet is too large. Despite the lack of evidence, the committee made a strong recommendation that a post-operative hearing test should be carried out 6 weeks after surgery, as this is in line with current practice and there could be serious developmental consequences for the child if there is unidentified ongoing hearing loss, such as profound speech, language, and developmental delay.</p><p>The committee were aware that children may still experience hearing loss after grommet interventions, and one committee member knew of a local audit that showed about 10% of children may need further grommet surgery. The committee discussed that parents should have the opportunity to contact audiology services to discuss the need for further hearing assessment for their child when they are concerned about recurrence of hearing loss after surgery. The committee felt that it may reduce delays in identifying recurrent hearing loss and therefore, appropriate interventions to address this and avoid adverse effects on the child’s development and wellbeing as people will not have to go through GP referral. Additionally, recently published Patient Initiated Follow Up (PIFU) guidance could be followed if appropriate and available for patients, enabling children to be discharged to a PIFU pathway (<a class="bibr" href="#niceng233er13.ref1" rid="niceng233er13.ref1">NHS 2022</a>). However, the committee were aware that there is variation in practice, and audiology services may or may not accept direct referrals depending on when reassessment is needed. They discussed that it is fairly common in practice that audiology services may only accept direct referrals for reassessment within one year after discharge, but reassessment may be carried out by GP if it is after one year. The committee agreed that the recommendation will give the flexibility for audiology services to accept direct referrals or to refer the child back to the GP if this is necessary.</p><p>In the committee’s experience, hearing loss is not always identified by parents and schoolteachers. If recurrent hearing loss is not noticed, the consequences for the child can be serious, as discussed above. Additionally, in the committee’s experience, grommets tend to fall out between 6 months and 18 months after surgery, with most grommets falling out about 6 months after surgery. However, children, parents or teachers may not necessarily know when grommets fall out. Therefore, children may be at risk of further hearing loss from about 6 months after surgery as hearing loss can return when grommets fall out. As a result, the committee agreed it may be important to have a 1-year follow-up with an age and developmentally appropriate hearing test (for example, audiogram) to pick up children with recurrent hearing loss that may not be obvious to the parents or teacher. It may also give the opportunity to identify other potential complications after grommet surgery, such as perforation of the tympanic membrane. The committee acknowledged there is current variation in practice regarding follow-up and were aware that a 1-year follow up plan may lead to a change in practice. It would lead to an increase in resources in places that currently discharge children from follow-up once it has been established that their hearing is normal (for example, 6 weeks post-surgery) but a decrease in resources for places that currently have a 3 to 6 month, or more regular, follow-up. The committee discussed that, given the lack of evidence and potentially significant change to practice, a strong recommendation in support of a 1-year follow-up could not be made. However, the committee agreed that having a 1-year follow-up after grommet surgery may help to reduce the risk of inequality that may otherwise occur if relying on families to identify and raise concerns. Some populations, for example parents and carers with their own communication difficulties, may be less likely to identify concerns or find it more difficult to raise any concerns they do identify which could disadvantage some children if a standard follow-up process is not followed. Therefore, the committee agreed that a 1-year follow-up with a hearing test should be considered.</p><p>The committee discussed that some children could be at increased risk of having unrecognised recurrent OME with hearing loss. For example, cognitive or communication difficulties may inhibit a child’s ability to recognise or communicate that they have recurrent hearing loss, so they may need more frequent follow-up or targeted follow-up plans. Therefore, the committee agreed that after surgery an individualised follow-up plan should be considered in these children as it is good clinical practice, in particular for children with a learning disability or craniofacial anomalies.</p><p>In the event the child continues to have hearing loss at the 6-week postoperative follow-up, the committee agreed investigations should be done into why this has happened (for example due to surgical complications or because grommets have fallen out early) to enable further appropriate treatment.</p><p>The committee acknowledged that it is important to understand the follow-up strategy required for children who undergo grommet insertion as this may have a significant impact on patient experience, NHS resources, and health outcomes, including hearing and quality of life. The committee also acknowledged that understanding the appropriate follow-up strategy for children with cognitive or communication difficulties is important as they may need targeted follow-up plans. However, there was no available evidence on the follow-up strategy after surgical treatment for OME-related hearing loss in children under 12 years. Therefore, the committee agreed that research is needed to inform appropriate follow-up strategy and made a research recommendation on the follow-up strategy after surgical treatment for OME-related hearing loss in children under 12 years (see <a href="#niceng233er13.appk">Appendix K</a>).</p></div><div id="niceng233er13.s1.1.9.4"><h5>Cost effectiveness and resource use</h5><p>This review question was not prioritised for economic analysis and therefore the committee made a qualitative assessment of the likely cost-effectiveness of their recommendations. The committee considered that it would be cost-effective to offer post-operative hearing tests at 6 weeks after surgery as they reasoned that unidentified ongoing hearing loss could result in serious developmental harms, which would impact negatively on quality of life and be costly to address. They noted that this was current practice and therefore their recommendation would not have any cost impact to the NHS.</p><p>The committee agreed it was difficult to determine the most cost-effective time for subsequent follow-up and they also noted there was considerable variation in practice. They did not recommend regular 3–6 month follow up, as occurs in some places, as they were unconvinced that such a resource intensive approach would be commensurate with any benefits obtained. However, the committee did make a weak recommendation for routine 1-year follow-up which would represent a change in practice and increase in resources for those areas where children are discharged once it is established that hearing is normal. The committee reasoned that some families may not identify and raise concerns in the absence of any such follow-up. However, the committee recognised there was not clinical or cost-effectiveness evidence to support this approach and this was reflected in the strength of the recommendation. The committee also recommended that a more regular and individualised follow-up plan could be considered for children with an increased risk of unrecognised OME with hearing loss. They reasoned that this was a relatively small population and so would not have a significant resource impact and that it would help mitigate adverse impacts on health-related quality of life.</p><p>The committee also made a recommendation to advise parents to seek reassessment of their child by audiology services if they have concerns about recurrence of hearing loss after surgery. Ideally, the committee believed that this should be possible from self-referral but recognised that direct referrals were not always possible. Again, the committee considered that this would only apply to a subset of the population having surgery and therefore they did not anticipate a large resource impact to the NHS whilst facilitating early identification of hearing loss.</p></div></div><div id="niceng233er13.s1.1.10"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendation 1.6.11 and the research recommendation on the follow-up strategy after surgical treatment for OME-related hearing loss in children under 12 years.</p></div></div><div id="niceng233er13.rl.r1"><h3>References – included studies</h3><ul class="simple-list"><div id="niceng233er13.rl.r1.1"><h4>Effectiveness</h4><ul class="simple-list"><p>No studies were identified which were applicable to this review question.</p></ul></div><div id="niceng233er13.rl.r1.2"><h4>Other</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng233er13.ref1"><p id="p-55">
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<strong>National Health Service (NHS) 2022</strong>
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</p>NHS (2022). Implementing patient initiated follow-up: guidance for local health and care systems. Available at: <a href="https://www.england.nhs.uk/publication/implementing-patient-initiated-follow-up-guidance-for-local-health-and-care-systems/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.england.nhs<wbr style="display:inline-block"></wbr>​.uk/publication/implementing-patient-initiated-follow-up-guidance-for-local-health-and-care-systems/</a> [Accessed 14/06/2023]</div></p></li></ul></div></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng233er13.appa"><h3>Appendix A. Review protocols</h3><p id="niceng233er13.appa.et1"><a href="/books/NBK595323/bin/niceng233er13-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</a><span class="small"> (PDF, 262K)</span></p></div><div id="niceng233er13.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng233er13.appb.et1"><a href="/books/NBK595323/bin/niceng233er13-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</a><span class="small"> (PDF, 193K)</span></p></div><div id="niceng233er13.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng233er13.appc.et1"><a href="/books/NBK595323/bin/niceng233er13-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</a><span class="small"> (PDF, 185K)</span></p></div><div id="niceng233er13.appd"><h3>Appendix D. Evidence tables</h3><div id="niceng233er13.appd.s1"><h4>Evidence tables for review question: What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng233er13.appe"><h3>Appendix E. Forest plots</h3><div id="niceng233er13.appe.s1"><h4>Forest plots for review question: What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</h4><p>No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="niceng233er13.appf"><h3>Appendix F. GRADE tables</h3><div id="niceng233er13.appf.s1"><h4>GRADE tables for review question: What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng233er13.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng233er13.appg.et1"><a href="/books/NBK595323/bin/niceng233er13-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</a><span class="small"> (PDF, 208K)</span></p></div><div id="niceng233er13.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng233er13.apph.s1"><h4>Economic evidence tables for review question: What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng233er13.appi"><h3>Appendix I. Economic model</h3><div id="niceng233er13.appi.s1"><h4>Economic model for review question: What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng233er13.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng233er13.appj.s1"><h4>Excluded studies for review question: What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</h4><div id="niceng233er13.appj.s1.1"><h5>Excluded effectiveness studies</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng233er13appjtab1"><a href="/books/NBK595323/table/niceng233er13.appj.tab1/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng233er13appjtab1" rid-ob="figobniceng233er13appjtab1"><img class="small-thumb" src="/books/NBK595323/table/niceng233er13.appj.tab1/?report=thumb" src-large="/books/NBK595323/table/niceng233er13.appj.tab1/?report=previmg" alt="Table 3. Excluded studies and reasons for their exclusion." /></a><div class="icnblk_cntnt"><h4 id="niceng233er13.appj.tab1"><a href="/books/NBK595323/table/niceng233er13.appj.tab1/?report=objectonly" target="object" rid-ob="figobniceng233er13appjtab1">Table 3</a></h4><p class="float-caption no_bottom_margin">Excluded studies and reasons for their exclusion. </p></div></div></div><div id="niceng233er13.appj.s1.2"><h5>Excluded economic studies</h5><p>No economic evidence was identified for this review.</p></div></div></div><div id="niceng233er13.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="niceng233er13.appk.s1"><h4>Research recommendations for review question: What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</h4><div id="niceng233er13.appk.s1.1"><h5>K.1.1. Research recommendation</h5><p>What should the follow-up strategy be after surgical treatment for OME-related hearing loss in children under 12 years?</p></div><div id="niceng233er13.appk.s1.2"><h5>K.1.2. Why this is important</h5><p>It is important to understand the follow up required for patients who undergo ventilation tube insertion as this can have a significant impact on patient experience and NHS resources. However, there was no available evidence on the follow-up strategy after surgical treatment for OME-related hearing loss in children under 12 years, and research is needed to inform appropriate follow-up strategy.</p></div><div id="niceng233er13.appk.s1.3"><h5>K.1.3. Rationale for research recommendation</h5><p id="niceng233er13.appk.et1"><a href="/books/NBK595323/bin/niceng233er13-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (132K)</span></p></div><div id="niceng233er13.appk.s1.4"><h5>K.1.4. Modified PICO table</h5><p id="niceng233er13.appk.et2"><a href="/books/NBK595323/bin/niceng233er13-appk-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (143K)</span></p></div></div></div></div></div><div class="fm-sec"><div><p>Final version</p></div><div><p>Evidence reviews underpinning recommendation 1.6.11 and research recommendation in the NICE guideline</p><p>This evidence review was developed by NICE</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2023.</div><div class="small"><span class="label">Bookshelf ID: NBK595323</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/37792982" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">37792982</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng233er13tab1"><div id="niceng233er13.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595323/table/niceng233er13.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng233er13.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_niceng233er13.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng233er13.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All children under 12 years who have had surgery for OME-related hearing loss.</td></tr><tr><th id="hd_b_niceng233er13.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_niceng233er13.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Follow-up of duration A</div></li><li class="half_rhythm"><div>Follow-up of frequency A</div></li><li class="half_rhythm"><div>Personnel/professional group carrying out the follow-up A</div></li><li class="half_rhythm"><div>Content of follow-up A</div></li></ul>
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</td></tr><tr><th id="hd_b_niceng233er13.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng233er13.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Follow-up of duration B</div></li><li class="half_rhythm"><div>Follow-up of frequency B</div></li><li class="half_rhythm"><div>Personnel/professional group carrying out the follow-up B</div></li><li class="half_rhythm"><div>Content of follow-up B</div></li></ul>
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<p>Any comparisons (within the categories of duration, frequency, personnel/professional group and content) reported in the evidence will be included.</p>
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</td></tr><tr><th id="hd_b_niceng233er13.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_niceng233er13.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<b>Critical</b>
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<ul><li class="half_rhythm"><div>Hearing (measured by pure tone audiometry or speech recognition thresholds, in dB HL)</div></li><li class="half_rhythm"><div>Additional intervention (e.g., repeat ventilation tube insertion, antibiotics)</div></li><li class="half_rhythm"><div>Parent/carer and/or child satisfaction</div></li></ul>
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</p>
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<p>
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<b>Important</b>
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<ul><li class="half_rhythm"><div>Persistent otorrhoea (ear discharge) (either clinically confirmed or parent-reported)</div></li><li class="half_rhythm"><div>Perforation of the tympanic membrane</div></li><li class="half_rhythm"><div>Quality of life (measured by OM8-30 questionnaire, Health Utilities Index Mark 3 (HUI3) questionnaire, Otitis Media-6 (OM-6) questionnaire, Quality of Life in Children’s Ear Problems (OMQ-14) questionnaire, Evaluation of Children’s Listening and Processing Skills (ECLiPS) questionnaire, Auditory Behaviour in Everyday Life (ABEL) questionnaire, Early Listening Function (ELF) questionnaire, Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) questionnaire, EuroQol 5 Dimensions (EQ-5D) questionnaire, Infant Toddler Quality of Life Questionnaire, or Child Heath Questionnaire)</div></li></ul>
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</p>
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</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">ABEL: Auditory Behaviour in Everyday Life; dB HL: decibel hearing levels; ECLiPS: Evaluation of Children’s Listening and Processing Skills; ELF: Early Listening Functioning; EQ: EuroQoL; HUI: Health Utilities Index; PEACH: Parents’ Evaluation of Aural/Oral Performance of Children; OM: otitis media; OME: otitis media with effusion; OMQ: Otitis Media Quality of Life</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng233er13appjtab1"><div id="niceng233er13.appj.tab1" class="table"><h3><span class="label">Table 3</span><span class="title">Excluded studies and reasons for their exclusion</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595323/table/niceng233er13.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng233er13.appj.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Code [Reason]</th></tr></thead><tbody><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Adkins, A P and Friedman, Ellen M (2005) Surgical indications and outcomes of tympanostomy tube removal. International journal of pediatric otorhinolaryngology
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69(8): 1047–51 [<a href="https://pubmed.ncbi.nlm.nih.gov/15927273" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15927273</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design does not meet inclusion criteria</p>
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<p>
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<i>The study investigates the factors affecting perforation healing after tympanostomy tube removal, and unclear whether participants had OME</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Charlett, Simon D and Knight, Lindsay C (2009) Pediatric myringoplasty: does previous adenoidectomy improve the likelihood of perforation closure?. Otology & neurotology : official publication of the American Otoloaical Society, American Neurotology Society [and] European Academy of Otology and Neurotology
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30(7): 939–42 [<a href="https://pubmed.ncbi.nlm.nih.gov/19692939" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19692939</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design does not meet inclusion criteria</p>
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<p>
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<i>The study investigates the effect of previous adenoidectomy on perforation closure after myringoplasty, and unclear whether participants had OME</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Conrad, David E, Levi, Jessica R, Theroux, Zachary A
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et al (2014) Risk factors associated with postoperative tympanostomy tube obstruction. JAMA otolaryngology-- head & neck surgery
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140(8): 727–30 [<a href="https://pubmed.ncbi.nlm.nih.gov/25009981" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25009981</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design does not meet inclusion criteria</p>
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<p>
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<i>The study investigates the factors associated with tube obstruction, and unclear whether participants had OME</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Hanes, Lauren A, Murphy, Amanda, Hatchette, Jill E
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et al (2015) Chronic Otitis Media with Effusion Is Associated with Increased Risk of Secondary Speech Surgery. Plastic and reconstructive surgery
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136(2): 343–349 [<a href="https://pubmed.ncbi.nlm.nih.gov/26218381" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26218381</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design does not meet inclusion criteria</p>
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<p>
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<i>Case-control study that investigates the association between otitis media with effusion requiring myringotomy tubes and the need for secondary speech surgery</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Hu, Shirley; Patel, Neha A; Shinhar, Shai (2015) Follow-up audiometry after bilateral myringotomy and tympanostomy tube insertion. International journal of pediatric otorhinolaryngology
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79(12): 2068–71 [<a href="https://pubmed.ncbi.nlm.nih.gov/26429601" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26429601</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- No comparison of interest</p>
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<p>
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<i>The study compared preoperative sound field threshold with postoperative sound field threshold, and preoperative air-bone gap with postoperative air-bone gap</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Kao, Richard; Kirse, Daniel J; Evans, Adele K (2014) Compliance with recommendations for tympanostomy tube follow-up: patient characteristics. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
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151(3): 489–95 [<a href="https://pubmed.ncbi.nlm.nih.gov/24894424" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24894424</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design does not meet inclusion criteria</p>
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<p>
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<i>The study investigates the association between follow-up behaviours and graduation (receiving discharge from care with “follow-up pro re nata” status), and unclear whether participants had OME</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Mughal, Zahir, Thirunavukarasu, Vijay, Darr, Adnan
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et al (2016) Follow-up care after grommet insertion in children: Review article. International journal of pediatric otorhinolaryngology
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88: 25–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/27497381" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27497381</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design does not meet inclusion criteria</p>
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<p>
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<i>Narrative review</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Nomura, Y., Oshima, H., Nomura, K.
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et al (2022) Outcome of the ‘waiting until spontaneous extrusion’ strategy for long-term tympanostomy tube placement in children with cleft palate. Acta Oto-Laryngologica
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142(34): 248–253 [<a href="https://pubmed.ncbi.nlm.nih.gov/35451931" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35451931</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design does not meet inclusion criteria</p>
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<p>
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<i>The study investigates the outcomes of the waiting until spontaneous extrusion strategy for long-term tympanostomy tube placement in children with cleft palate</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Parlea, E; Georgescu, M; Calarasu, R (2012) Tympanometry as a predictor factor in the evolution of otitis media with effusion. Journal of medicine and life
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5(4): 452–4 [<a href="/pmc/articles/PMC3539835/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3539835</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23346249" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23346249</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Non-OECD high-income country</p>
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<p>
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<i>Romania</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Payten, C.L., Eakin, J., Smith, T.
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et al (2020) Outcomes of a multidisciplinary Ear, Nose and Throat Allied Health Primary Contact outpatient assessment service. Clinical Otolaryngology
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45(6): 904–913 [<a href="/pmc/articles/PMC7821116/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7821116</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32780943" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32780943</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design does not meet inclusion criteria</p>
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<p>
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<i>The study investigates the service impact of allied health primary contact clinics on wait-times and access to treatment, and comparison not of interest</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Powell, J, Powell, S, Lennon, M
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et al (2015) Paediatric ventilation tube insertion: our experience of seventy-five children in audiology-led follow-up. Clinical otolaryngology : official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
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40(4): 385–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/25598389" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25598389</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design does not meet inclusion criteria</p>
|
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<p>
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<i>Non-comparative study</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Stephens, M B (2001) Does delaying placement of tympanostomy tubes have an adverse effect on developmental outcomes in children with persistent middle ear effusions?. The Journal of family practice
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50(8): 651 [<a href="https://pubmed.ncbi.nlm.nih.gov/11509152" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11509152</span></a>]
|
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Study design does not meet inclusion criteria</p>
|
|
<p>
|
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<i>The study investigates the association between delaying placement of tympanostomy tubes and developmental outcomes, and comparison not of interest</i>
|
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</p>
|
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Uppal, Sandeep, Lee, Carline, Mielcarek, Mateusz
|
|
et al (2004) A comparison of patient satisfaction with conventional and nurse led outpatient follow-up after grommet insertion. Auris, nasus, larynx
|
|
31(1): 23–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/15041050" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15041050</span></a>]
|
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Study design does not meet inclusion criteria</p>
|
|
<p>
|
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<i>Cross-sectional survey and audit of practice, and unclear whether participants had OME</i>
|
|
</p>
|
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</td></tr><tr><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Wallace, H C and Newbegin, C J R (2004) Does ENT outpatient review at 1-week post ventilation tube insertion improve outcome at 1 month in paediatric patients?. Clinical otolaryngology and allied sciences
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29(6): 595–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/15533143" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15533143</span></a>]
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</td><td headers="hd_h_niceng233er13.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Population does not meet inclusion criteria</p>
|
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<p>
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<i>Only about 18% of participants had OME and results not presented separately for them</i>
|
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</p>
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</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">OECD: Organisation for Economic Co-operation and Development; OME: otitis media with effusion</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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