Audiology-led follow-up clinics for post-grommet insertion are “a viable option” for most children who have the surgery, a Perth study shows.
The study in 93 children found the clinics provided “efficient, high-quality care” with three-quarters of paediatric patients not requiring ENT input or review post-operatively.
Researchers said, in the August edition of the International Journal of Paediatric Otorhinolaryngology, that results added to the body of evidence that the clinics were feasible and supported a shift towards more interdisciplinary models of care, which could address challenges faced by ENT services.
They said the novel approach could alleviate demands on ENT services and improve clinical outcomes for affected children.
Researchers said otitis media (OM) had a high prevalence in childhood and grommet insertion was the most common surgical treatment for OM. In tertiary hospitals, OM was also one of the most common reasons for paediatric surgery.
“The public health system in Australia faces considerable strains, including high demand for ear, nose and throat specialists,” they wrote. “Extending the scope of practice for audiologists to manage post-operative care for children receiving grommets has the potential to alleviate this burden.”
The non-randomised, cross-sectional study investigated the efficacy and feasibility of the clinic for managing paediatric patients after grommet insertion at a tertiary teaching hospital in Western Australia.
Senior audiologists reviewed children at six weeks and 10 months post-operatively, escalating care to an ENT specialist if abnormalities were observed. Children with normal hearing and patent grommets were reviewed and discharged by the audiologist.
At six weeks, 72/93 (77 %) presented with in-situ grommets and normal hearing, while 21/93 (22 %) were escalated for immediate ENT care.
At the 10-month review, 54/72 (75 %) were discharged without further ENT intervention, and 18/72 (25 %) required additional ENT investigation.
“Despite its benefits, not all Australian children can access ventilation tube insertion (VTI) surgery in a timely manner. Children with OM often experience delayed access to specialist care due to the increasing demand for Australia’s public hospital outpatient clinics,” they said.
Geographic barriers resulted in delayed access to specialist care for children living in rural and remote regions. In WA, private care and long waitlists in the public hospital system resulted in inequal access to care.
“Children with OM often exceed the clinically recommended timeframes to receive their initial ENT outpatient consultation, which may lead to worsening OM, poor quality of life and a significant increase in economic burden to patients and healthcare system,” they said.
Extended scope of practice
Using audiologists to manage children with OM was gaining attention and extended scope (ES) audiologists had been proposed to alleviate system burdens by undertaking responsibilities traditionally reserved for specialists, they added.
“This model allows an ES audiologist to offer assessment, diagnosis and recommendation for children with semi-urgent ear health issues, holding the potential to expedite clinical services and improve the efficiency and satisfaction of healthcare delivery in children with OM.
“In Australia, the use of ES audiologists in paediatric ENT outpatient clinics has shown to be both safe and effective in the management of paediatric patients, and an improvement in the utilisation of specialist resources when compared to traditional medical services.”
Previous research found that for children with severe OM, the ES audiology clinic showed an increase in surgical intervention from 57 % to 82 % compared with the standard medical model. The clinic also resulted in significant reduction of waiting time for the initial consultation (417 days – 96 days) and grommet insertion (627 days – 225 days).”
The researchers were Dr Dayse Tavora-Vieira, Ms Vivien Schrader, Dr Marcus Voola, Ms Caris Bogdanov, Ms Tamara Veselinovic and Dr Robyn Choi. Their workplaces include Fiona Stanley Fremantle Hospitals Group, the University of Western Australia’s Medical School, Division of Surgery, the University of Western Australia’s School of Human Sciences, Curtin University, and Wesfarmer’s Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, the University of Western Australia.
They said up to 80% of Australian children had had OM before four years of age, and approximately 40% experienced recurrent OM by seven years of age. Prevalence was greater in populations with reduced access to healthcare and lower socioeconomic backgrounds including Aboriginal and Torres Strait Islander children, children from low-income households and those living in rural and remote areas.
OM was associated with conductive hearing loss of a maximal level of approximately 60dBHL, with those individuals with higher volumes of effusion experiencing higher degrees of hearing loss, they said. Untreated it could lead to delays in speech and language development, development of auditory processing skills, increases in behavioural problems and mental health conditions. Recurrent and persistent OM could have long-term effects such as permanent hearing loss in adulthood.
