by Michael Woodhead

Doubts have been raised about the appropriateness of some ENT procedures in children, with new data showing an apparent lack of effect of grommet insertions.

Analysing rates of health service usage by children before and after ENT surgery, researchers at the University of Sydney found that some procedures such as tonsillectomy appeared to be justified by the sharp decline in Medicare claims following the operation.

Children who had a surgery had more than double rates of health service usage than other children beforehand, which the authors say show justified the need for intervention.

However, children undergoing myringotomy showed no change in rates of health care use after having grommets inserted.

“If myringotomy had provided relief, this should have been demonstrated by a decrease in services, at least during the time the tubes were in situ. We did not see such a decrease,” they write in the Journal of Paediatrics and Child Health this month (Online October 26).

The only benefit of myringotomy on medical service usage was seen in children under four who also underwent adenoidectomy, the report authors say.

“This supports a hypothesis that surgery at such a young age indicates the presence of more severe problems with obstructive symptoms warranting intervention,” they write.

The figures were based on  a retrospective analysis of Medicare claims over an eight year period for more than 6000 children in NSW whose parents had access to privately-funded ENT surgery.