Govt eyes cuts to elective surgery

In a recent article in the Herald ,the NZ National Health Committee has to find savings of $30 million this financial year from elective procedures deemed to be of little benefit. The New Zealand Government are using data from a  similar committee in Wales. The Welsh Committee has come up with a specific procedures list, under 17 surgical and dental headings, including tonsillectomy, grommets, varicose veins, haemorrhoids, dilatation and curettage, hysterectomy, gallbladder removal, caesarean section, lower-back procedures, circumcision, eye-lid surgery, nose surgery and surgery to correct protruding ears.

The committee said it had completed a technological note on the use of ventilation tube grommets for treating middle-ear infections (otitis media).

"The evidence indicates that the use of ventilation tubes is of limited value in treating otitis media with effusion, although it does not suggest that it should be stopped completely."

BUT when you look at what has happened in UK I found a well written article from the Daily Mail. This talks about the dangers of delaying grommet insertion. New research shows the number of referrals in UK to hospital for treatment of glue ear - a chronic condition that is the biggest single cause of hearing loss in children - has plummeted in the past few years.

The article also  includes information on a New Zealand Study.

"The study of more than 1,000 children born in New Zealand in the early Seventies suggests early glue ear affects behaviour, IQ and reading, into late teens.

It found that compared with 'normal' children, those with a history of glue ear had lower IQ up to the age of 13, more hyperactive and inattentive behaviour up to 15, and reduced reading ability up to 18.

It concluded that 'early middle ear disease history appears to have a deleterious effect on reading ability, verbal IQ and behaviour problems'."

The people of Northland need to be very wary of a new breed of Health Administrator in Wellington, many of whom have recently been exported from UK, who have plans to cut services particularly to the  poorest children in New Zealand.

Adenoidectomy in Children with Otitis media with effusion.

A recent randomised controlled trial in UK, MRC multicentre Otitis Media Group (2012) has shown that adenoidectomy leads to longer term hearing benefits than grommets alone.
-In the no-treatment group over a 2 year period  only one in five of the children had complete remission.
-The tympanostomy tube group nearly all returned to near normal hearing levels in the short term.
-But adjuvent adenoidectomy provided a prolonged advantage by preventing recurrence of OME after extrusion in one in four children.

Of course a study like this still doesn't have all the answers.

• The question is would all children benefit from adenoidectomy with grommet insertion. 
• Does the size of the adenoids matter or the history of UTIs. 
• One has to weigh up the risks of adenoidectomy. 
• Would just putting in longer lasting grommets be the option in-spite of the probable  higher drum damage from larger grommets. 
• The availability of resources may be the main obstacle to adjuvant adenoidectomy as a first-line intervetion.

In Northland we tend to do an Adenoidectomy on all children who are booked for their second lot of grommets as well as children with significant nasal symptoms with their first set of grommets. Resources are certainly a factor though.