An objective scoring system for the management of otitis media with effusion

Abstract Otitis media with effusion (OME) is one of the commonest otological conditions of childhood and grommet insertion is the commonest operation carried out in the UK [Br. Med. J. 300 (1990) 1551]. The decision to subject a child to grommet insertion is usually subjective. There is considerable pressure on the ENT specialty to justify the large number of grommet insertion operations not only from the government and purchasers but also from providers and patients. In this article, we describe an objective scoring system validated retrospectively on 300 consecutive patients with the aim of finding a symptom score above which surgery is indicated. The case notes of 300 children with a diagnosis of OME who were seen at the ENT outpatient department of a Birmingham hospital were reviewed and given a score based on the symptoms and audiological results at the time of their initial consultation. The score was then compared with operative findings to determine any correlation. The scoring system had 92% sensitivity and 75% positive predictive value, 72% of children receiving appropriate treatment [95% CI 67% to 77%].