Article type
Year
Abstract
Introduction/Objective: To assess current clinical management in the Netherlands of children who failed the Ewing hearing test and compare this with practice guidelines and outcomes of RCTs.
Methods: 600 out of 880 children were identified who failed a routine screening test for hearing impairment at the age of ca. 1 year in 1994 in a particular area in the Netherlands. Their parents were sent a questionnaire, asking about subsequent consultation of their GP, referral to the outpatient clinic, clinical management by the ENT specialist, and current hearing status of their child. 33 of the GPs, and 22 of the ENT-specialists were then interviewed by telephone, asking about their management of these children and their rationale for major decisions. RCTs in the area of glue ear were identified using Medline.
Results: 427 of the 600 questionnaires were returned. 76 % had visited their GP in relation to the screening test. According to the parents, the GP reached the diagnosis of glue ear in 35 %, established a hearing loss in 18 %, and did not reach a diagnosis in 61 % of the cases. 59 % were referred to an ENT specialist, 1 % was referred to an Audiological Centre, 3 % got medication, 10 % was invited for a return visit, and 19 % was reassured and given the advice that no further action was required. Of the 250 children who visited an ENT-specialist, 86 % was diagnosed with glue ear and 0.4 % with a perceptive hearing loss. 53 % received grommets, 39 % adenoidectomy, 3 % tonsillectomy, and 9 % medical treatment. 6 % were referred to an Audiological Centre, and 12 % received no treatment. At the time of filling out the questionnaire, 70 % of the parents rated the hearing status of their child as excellent, 23 % of the children was still under medical supervision. When asked to provide reasons for their decisions, GPs frequently cite the benign natural course of glue ear, and doubts with respect to the validity of the Ewing test as reasons for not referring these children. Parents' anxiety about their child's development is frequently cited as a major reason for referral. As a major reason for inserting grommets, ENT specialists cite the susceptibility of these children to impaired language and speech development as the result of prolonged bilateral conductive hearing losses. Using Medline, we identified 7 RCTs comparing different surgical regimens in children with OME; 2 of these had included children corresponding to the age of 1 - 2. Both studies show that grommets result in earlier resolution of the effusion and restoration of the pre-effusion level, at the expense of a higher rate of complications.
Discussion: A major rationale for practice decisions, viz. development of the child, has not been addressed in either of the RCTs; such discrepancy may partly explain persisting uncertainty regarding optimal management of glue ear.
Methods: 600 out of 880 children were identified who failed a routine screening test for hearing impairment at the age of ca. 1 year in 1994 in a particular area in the Netherlands. Their parents were sent a questionnaire, asking about subsequent consultation of their GP, referral to the outpatient clinic, clinical management by the ENT specialist, and current hearing status of their child. 33 of the GPs, and 22 of the ENT-specialists were then interviewed by telephone, asking about their management of these children and their rationale for major decisions. RCTs in the area of glue ear were identified using Medline.
Results: 427 of the 600 questionnaires were returned. 76 % had visited their GP in relation to the screening test. According to the parents, the GP reached the diagnosis of glue ear in 35 %, established a hearing loss in 18 %, and did not reach a diagnosis in 61 % of the cases. 59 % were referred to an ENT specialist, 1 % was referred to an Audiological Centre, 3 % got medication, 10 % was invited for a return visit, and 19 % was reassured and given the advice that no further action was required. Of the 250 children who visited an ENT-specialist, 86 % was diagnosed with glue ear and 0.4 % with a perceptive hearing loss. 53 % received grommets, 39 % adenoidectomy, 3 % tonsillectomy, and 9 % medical treatment. 6 % were referred to an Audiological Centre, and 12 % received no treatment. At the time of filling out the questionnaire, 70 % of the parents rated the hearing status of their child as excellent, 23 % of the children was still under medical supervision. When asked to provide reasons for their decisions, GPs frequently cite the benign natural course of glue ear, and doubts with respect to the validity of the Ewing test as reasons for not referring these children. Parents' anxiety about their child's development is frequently cited as a major reason for referral. As a major reason for inserting grommets, ENT specialists cite the susceptibility of these children to impaired language and speech development as the result of prolonged bilateral conductive hearing losses. Using Medline, we identified 7 RCTs comparing different surgical regimens in children with OME; 2 of these had included children corresponding to the age of 1 - 2. Both studies show that grommets result in earlier resolution of the effusion and restoration of the pre-effusion level, at the expense of a higher rate of complications.
Discussion: A major rationale for practice decisions, viz. development of the child, has not been addressed in either of the RCTs; such discrepancy may partly explain persisting uncertainty regarding optimal management of glue ear.