Otitis media with effusion (OME) or glue ear has increased as a diagnosis in primary care over the past decade while grommet rates have declined. When developmental concerns are raised by parents or the child is noted to have frequent ear related problems, this often leads to referral and request for further expert assessment. Referral rates show more variability than for other ENT conditions such as tonsillectomy, and may partly relate to the present relative lack of accurate structured assessments in primary care.

Selection of appropriate children for referral and treatment remains a clinical priority with markers of severity and persistence being highly relevant but having some scope for improved utility. Whereas previously early intervention to prevent disability developing was part of the underlying philosophy of treatment, current interpretation of existing evidence is challenging this by highlighting the clinical heterogeneity in surgical trials, with potential for differential treatment effects.

The trials reported in Cochrane excluded many “syndrome” children who usually receive grommets, and also those with speech, …