US study questions need for grommets

By MONIQUE DEVEREUX health reporter

One of the most common operations performed on children to treat glue ear may not make any difference to their hearing and speech development, an American study claims.

But ear, nose and throat specialists here disagree and say the risks of a child suffering hearing loss are much higher without inserting grommets.

The study, by one of the world's leading experts on hearing problems in children, Dr Jack Paradise, of the University of Pittsburgh, is reported in The New England Journal of Medicine.

It says the operation to insert the tiny valves in the eardrums of children with middle-ear infections "does not measurably improve developmental outcomes" up to the age of three.

The authors say that that raises doubts about the wisdom of exposing young children to the risks of the surgery when there is no benefit.

Dr Paradise and colleagues selected 429 children with persistent glue ear and allocated half for immediate operation. The remainder were monitored for nine months, and given the operation only if the problem persisted.

Their results showed that although grommets reduced the incidence of glue ear in the treated group, they did not improve their scores on tests of behaviour, language or speech.

But Waikato ENT specialist Malcolm Giles says the single study did not offer enough evidence to convince him that children under the age of 3 would be better off without grommets.

He said the operation took no longer than 15 minutes and was usually completed under a light anaesthetic.

The children were able to go home within a couple of hours.

"In most cases the risks of complications with surgery are much less than that of leaving the child to suffer with glue ear," he said.

The Starship children's hospital clinical director of ENT, Colin Barber, said the American study was useful, but "it's not the final answer."

He pointed out that the study looked at the difference in development between children with long-term glue ear problems and those with a shorter history of glue ear.

They did not compare the development of the children with other children who had not suffered any glue ear problems. One in 10 NZ children suffer some kind of hearing loss, the main causes in the middle and outer ear being glue ear and impacted wax.