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Surgical Management of Otitis Media with Effusion in Children Surgical management of otitis media with effusion in children Surgical management of otitis media with effusion in children National Collaborating Centre for Women’s and Children’s Health Other NICE guidelines produced by the National Collaborating Centre for Women’s and Children’s Health include: • Antenatal care: routine care for the healthy pregnant woman • Fertility: assessment and treatment for people with fertility problems • Caesarean section • Type 1 diabetes: diagnosis and management of type 1 diabetes in children and young people • Long-acting reversible contraception: the effective and appropriate use of long-acting reversible contraception • Urinary incontinence: the management of urinary incontinence in women • Heavy menstrual bleeding • Feverish illness in children: assessment and initial management in children younger than 5 years • Urinary tract infection in children: diagnosis, treatment and long-term management • Intrapartum care: care of healthy women and their babies during childbirth • Atopic eczema in children: management of atopic eczema in children from Surgical management of birth up to the age of 12 years Surgical management of Guidelines in production include: • Antenatal care (update) otitis media with effusion • Diabetes in pregnancy • Induction of labour (update) • Surgical site infection • Diarrhoea and vomiting in children under 5 in children • When to suspect child maltreatment • Meningitis and meningococcal disease in children • Neonatal jaundice • Idiopathic constipation in children • Hypertension in pregnancy Enquiries regarding the above guidelines can be addressed to: National Collaborating Centre for Women’s and Children’s Health King’s Court Fourth Floor 2–16 Goodge Street London W1T 2QA [email protected] A version of this guideline for parents/carers and the public is available from the NICE website (www.nice.org.uk/CG060) or from the NHS Response Line (0870 1555 455); quote reference Clinical Guideline number N1462. Clinical Guideline February 2008 February 2008 Published by the Royal College of Obstetricians and Gynaecologists. Clinical Guideline To purchase further copies and for a complete list of RCOG Press titles, February 2008 RCOG RCOG Press Press visit: www.rcogbookshop.com 2008 Funded to produce guidelines for the NHS by NICE Surgical management of otitis media with effusion in children National Collaborating Centre for Women’s and Children’s Health Commissioned by the National Institute for Health and Clinical Excellence February 2008 RCOG Press Published by the RCOG Press at the Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’s Park, London NW1 4RG www.rcog.org.uk Registered charity no. 213280 First published 2008 © 2008 National Collaborating Centre for Women’s and Children’s Health No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK [www.cla.co.uk]. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use. While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising. ISBN 978-1-904752-45-5 NCC-WCH Editor: Andrew Welsh Original design: FiSH Books, London Typesetting: Andrew Welsh Proofreading: Katharine Timberlake (Reedmace Editing) Index: Jan Ross (Merrall-Ross (Wales) Ltd) Printed by Henry Ling Ltd, The Dorset Press, Dorchester DT1 1HD Contents Guideline Development Group membership and acknowledgements iv Guideline Development Group iv Acknowledgements iv Stakeholder organisations v Abbreviations vii Glossary of terms viii 1 Scope and methodology 1 1.1 Introduction 1 1.2 Aim of the guideline 1 1.3 Areas within the scope of the guideline 1 1.4 Areas outside of the scope of the guideline 2 1.5 For whom is the guideline intended? 2 1.6 Who has developed the guideline? 2 1.7 Guideline development methodology 3 1.8 Schedule for updating the guideline 5 2 Summary of recommendations and care pathways 6 2.1 Key priorities for implementation (key recommendations) 6 2.2 Summary of recommendations 7 2.3 Research recommendations 9 2.4 Care pathways 10 3 Clinical presentation, diagnosis and management 14 3.1 Clinical presentation 14 3.2 Diagnosis of OME 18 3.3 Management of OME 28 3.4 Management of OME in children with Down’s syndrome 45 3.5 Management of OME in children with cleft palate 47 4 Information for children, parents and carers 51 4.1 Information for children, parents and carers 51 Appendix A Declarations of interest 52 Appendix B Clinical questions 53 Appendix C Economic evaluation of alternative management strategies for OME in children 54 References 66 Index 69 Search strategies CD-ROM Evidence tables CD-ROM Excluded studies CD-ROM iii Guideline Development Group membership and acknowledgements Guideline Development Group Peter Bull Consultant ENT Surgeon, GDG Chair Helen Barrow Patient/Consumer Representative Gareth Davies Patient/Consumer Representative (Chief Executive, Cleft Lip and Palate Association (CLAPA)) Sarita Fonseca Consultant Paediatrician (Audiology) Mark Haggard Epidemiologist (expert adviser to the GDG) John Hart General Practitioner Teresa Loxley Senior Chief Paediatric Audiologist Wanda Neary Consultant Community Paediatrician (Paediatric Audiology) Kenneth Pearman Consultant ENT Surgeon Ewa Raglan Consultant Audiovestibular Physician Patrick Sheehan Consultant ENT Surgeon Jo Williams Advanced Nurse Practitioner in ENT Ian Williamson Senior Lecturer in Primary Medical Care National Collaborating Centre for Women’s and Children’s Health (NCC-WCH) staff Monica Lakhanpaul Clinical Co-Director, Children’s Health Rajesh Khanna Senior Research Fellow Paul Jacklin Senior Health Economist Itrat Iqbal Health Economist Eva Gautam-Aitken Project Manager Debbie Pledge Senior Information Scientist Rupert Franklin Work Programme Coordinator Andrew Welsh Editor Acknowledgements Additional support was received from: • Anna Bancsi, Martin Dougherty, Angela Kraut, Roz Ullman and Samantha Vahidi at the NCC-WCH • Tim Stokes, Nicole Elliott, and Emma Banks at the National Institute for Health and Clinical Excellence (NICE) • Sam Majumdar at the Royal Hallamshire Hospital • Wendy Edwards from the Healing Foundation Patient Information Working Party • Jonathan Sandy and Andy Ness and their team at University of Bristol Dental School who kindly gave access to their review prior to publication • Simon Dixon, Senior Lecturer in Health Economics at the School of Health and Related Research (ScHARR), University of Sheffield, for analysis used in the health economics appendix • the Patient and Public Involvement Programme (PPIP) for NICE whose glossary was adapted for use in this guideline. iv Guideline Development Group membership and acknowledgements Stakeholder organisations Addenbrookes NHS Trust Afiya Trust, The Association of Medical Microbiologists Barnsley Hospital NHS Foundation Trust Bedfordshire PCT Berkshire Healthcare NHS Trust Bolton Council Bradford Hospitals NHS Trust British Association for Paediatric Otorhinolaryngology British Association of Audiovestibular Physicians British Association of Paediatricans in Audiology (BAPA) British Association of Otorhinolarynoglogists – Head and Neck Surgeons British Association of Teachers for the Deaf (BATOD) British Homeopathic Association British National Formulary (BNF) Calderdale PCT CASPE Research Charing Cross Hospital Chase Farm Hospital Commission for Social Care Inspection Connecting for Health Cornwall & Isles of Scilly PCT Department of Health Derriford Hospital Downs Syndrome Medical Interest Group (DSMIG) Dudley Group of Hospitals NHS Trust East & North Herts PCT & West Herts PCT Glan Clwyd District General Hospital Health Commission Wales Healthcare Commission Home Office Kettering General Hospital Leeds Teaching Hospitals NHS Trust Lincolnshire PCT Medicines and Healthcare Products Regulatory Agency Medway NHS Trust Milton Keynes PCT Morecombe Bay Health Trust MRC Multicentre Otitis Media Study Group National Deaf Children’s Society National Patient Safety Agency National Public Health Service – Wales NCCHTA NHS Health and Social Care Information Centre NHS Plus NHS Quality Improvement Scotland North Tees PCT Obesity Management Association OCD Today PERIGON Healthcare Ltd PRIMIS+ Regional Public Health Group – London Royal College of Midwives Royal College of Nursing Royal College of Paediatrics and Child Health Royal College of Pathologists Royal College of Physicians of London Royal College of Speech and Language Therapists Royal College of Surgeons of Edinburgh v Surgical management of otitis media with effusion in children Royal National Throat, Nose & Ear Hospital Royal United Hospital Scottish
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