Otitis Media with Effusion


When to refer to the Paediatric Hearing Service (Audiology) 

Refer after 6 weeks of significant deafness. Usual wait time is 6 weeks therefore testing is done at 3 months in line with national guidance.

Patients will be considered for the insertion of grommets when there is evidence of functional impairment caused by hearing loss of at least 25-30dB, on at least 2 documented occasions over the active observation period. 

At least one of the following needs to apply:

  • Delay in speech development
  • Educational or behavioural problems attributable to the hearing loss
  • A significant second medical condition that may itself lead to developmental problems e.g. Down’s syndrome, Turner’s syndrome or cleft palate

If hearing loss is causing severe functional impairment you can refer immediately and do not have to wait 6 weeks.

Intranasal steroidscan be beneficial where there is evidence of nasal congestion/obstruction due to rhinitis/atopy/adenoidal hypertrophy e.g. Fluticasone 1 puff once daily for 6 weeks in children aged 4 and older. 

Antibioticscan be beneficial where there is purulent nasal discharge which may be due to sinusitis. Phenoxymethylpenicillin or clarithromycin (if penicillin allergic) for 5 days as per RCHT Microbiology guidelines.


Hearing tests will be undertaken in schools and community clinics. Audiology works closely with ENT – where necessary they will refer rapidly to ENT.


When to refer to ENT rather than the paediatric hearing service

Children with additional surgical problems such as rhinitis, blocked nose


Information to include in the referral

  • How the hearing loss affects the child
  • The duration of the hearing loss
  • If you think the child may have extra difficulty wearing headphones and responding to sound e.g. has learning difficulties, please note it in the letter. Testing with extra staff and equipment will be arranged.

Otitis media without effusion

Insertion of grommets in children is commissioned when there have been at least five recurrences of acute otitis media, which required medical assessment and/or treatment, in the previous year



Insertion of grommets in adults is commissioned where patients meet the criteria below:

A middle ear effusion causing measured conductive hearing loss of 30dbHL or worse averaged at 0.5, 1, 2, & 4kHz, persisting for at least six months and resistant to medical treatments. In addition the patient must have significant functional impairment. The possible alternative treatment option of a hearing aid should be discussed

Insertion of grommets is not routinely commissioned for pain in the ears (e.g. on flying), for Eustachian tube dysfunction (in the absence of other qualifying symptoms/signs (e.g. middle ear effusion) or for the treatment of Ménière’s disease.


Updated November 2020


Mr Venkat Reddy ENT Consultant

Dr Andrew Sharp GP Lead ENT