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Grommet Surgery in Children With Orofacial Clefts in England
Insights
Grommet insertion for children with orofacial clefts in England varies significantly. Over a third received grommets before age five, with timing and repeat procedures differing by cleft type and socioeconomic factors.
Area of Science:
- Pediatric Otolaryngology
- Craniofacial Surgery
- Public Health Policy
Background:
- Otitis media with effusion is common in children with orofacial clefts.
- Grommet insertion (ventilation tube insertion) is a common treatment for persistent otitis media with effusion.
Purpose of the Study:
- To assess the practice of grommet insertion in children under five with orofacial clefts in England.
- To identify variations in grommet insertion based on clinical and demographic factors.
Main Methods:
- Analysis of national administrative data from NHS hospitals in England.
- Inclusion of children born between 1997 and 2005 who underwent surgical cleft repair.
- Examination of grommet insertion rates, timing, and repeat procedures.
Main Results:
- 36.5% of 8,269 children received grommets before age five.
- 33.2% had their first grommet insertion during primary cleft repair; 33.3% had multiple procedures.
- Grommet use varied by cleft type (palate vs. lip), additional anomalies, socioeconomic deprivation, and region.
Conclusions:
- Grommet insertion practices for children with clefts show considerable variation.
- Further investigation is needed into disparities related to socioeconomic deprivation and geographic region.
Objective:
To assess grommet insertion practice in the first 5 years of life among children with an orofacial cleft in England.
Design:
Analysis of national administrative data of hospital admissions.
Setting:
National Health Service hospitals, England.
Patients:
Patients born between 1997 and 2005 who underwent surgical cleft repair.
Intervention:
Children receiving grommets before the age of 5 years.
Outcome Measures:
The proportion of children receiving grommets before the age of 5 years, the timing of the first grommet insertion, and the proportion of children having repeat grommet insertions were examined according to cleft type, the absence or presence of additional anomalies, socioeconomic deprivation, and region of residence.
Results:
The study included 8,269 children. Before the age of 5 years, 3,015 (36.5%) children received grommets. Of these, 33.2% received their first grommets at primary cleft repair and 33.3% underwent multiple grommet insertion procedures. The most common age for the first procedure was between 6 and 12 months. Children with a cleft affecting the palate were more likely to receive grommets than children with a cleft lip alone (45.5% versus 4.5%). Grommet insertion practice also varied according to year of birth, absence or presence of additional anomalies, socioeconomic deprivation, and region of residence.
Conclusion:
Grommets practice in children with a cleft appears to vary according to their clinical characteristics. The differences in practice observed according to deprivation and region of residence need to be further explored.
