Grommets

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Grommets Quality development project in Region
of Southern Denmark
A multi-center study by 24 ENT-specialists
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24 participating doctors

• Peter Vorre and Allan Suhr Olesen, Sønderborg
• Axel Fogh, Tønder, Jan Nabe-Nielsen, Esbjerg
• Poul Hertel, Haderslev
• Per Monrad, Susanne Haug, Jørgen Dyrmose, Vejle
• Preben Bjerregaard, Askov
• Anette Kjær and Hans Henrik Fischer, Fredericia
• Johnny Lunding, Middelfart
• Mette Teilgaard Kristensen, Assens
• Morten Johansen, Fåborg
• Berit Svendstrup and Jürg Zimmermann, Svendborg
• Mogens Worsøe-Sørensen, Peer Karup, Ulf
  Schønsted-Madsen, Pia Juul Andersen, Lotte Jung,
  Ole Larsen, Lars Gosvig, Mogens
  Fiellau-Nikolajsen, Odense

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Time schedule

• Pilot project summer, autumn 2007
• Introductory meeting end of November 2007
• Inclusion of patients January till March 2008
• Second registration at the 3-month check-up
  April till June 2008
• Follow-up meetings autumn 2008 - spring 2009
• Presentation at the spring meeting 2009 in the
  Danish College of Oto-laryngology Head and Neck
  Surgery (DSOHH)

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Treatment of children with serous otitis media
(SOM) and acute otitis media (AOM) is much
debated. The aim of the study was to elucidate

• Are too many children being treated?
• Are the right children being treated?
• Are DSOHHs recommended guidelines for first-time
  grommet treatment being followed?
• How the parents judge the grommet treatment of
  their childd based on softer quality values not
  normally measured upon?

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Hypotheses

• 1. The practising ENT specialists indication
  for grommet insertion is in agreement with the
  general guidelines drawn up by Danish specialists
• Standard 80 of the children are being treated
  within the guidelines
• Indicator Observation time of SOM prior to
  grommet insertion
• 2. The childrens social functioning is improved
• The childs social functioning is assessed based
  on the results of a questionnaire study to the
  parents prior to and 3 months after grommet
  insertion
• An improvement in the childs hearing before and
  after surgery can be objectively measured
• Middle ear pressure by means of tympanometry and
  oto-acoustic emissions (OAE) is measured before
  and after grommet insertion.

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Inclusion criteria

• First tympanic membrane grommet in children lt 7
  years
• With/without siblings with/without grommets
• Relevant SOM, AOM rec. gt 2/6 months or both
• Suitable for outpatient grommet insertion

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Typical age. Overweight of boys.
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Parents
77 AF BØRNENE KOM FRA E.L. ELLER PÅ FORÆLDRENES
EGET INITIATIV
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Parents
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Questionnaire to parents before surgery
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Parents
Forældrene angav på en visuel skala problemernes
størrelse
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Parents
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Parents
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Questionnaire to the ear specialist prior to
surgery
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ENT- specialist
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ENT- specialist
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(No Transcript)
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ENT- specialist
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Parents
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Parents
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Parents
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Parents
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Parents
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Parents
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Parents
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3 months after surgery
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Grommet treatment to children with SOM og AOM.
The study showed

• Do too many children receive the treatment?
• Answer No
• The study shows that there are definite objective
  findings as basis for grommet insertion and that
  an observation period of more than 3 months is
  complied with - as recommended by Dansk Selskab
  for Oto-laryngologi-Hoved og Halskirurgi (DSOHH).
  

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Grommet treatment to children with SOM and AOM.
The study showed

• Are the right children being treated?
• Answer Yes
• The parents assess, that the insertion of
  grommets has a markedly positive effect on the
  childs and the familys wellbeing, and that the
  effect occurs immediately or after a few days

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Grommet treatment to children with SOM og AOM.
The study showed

• Have the guidelines from the Danish College of
  Otolaryngology Head and Neck Surgery (DSOHH)
  regarding first-time grommet treatment been
  followed? Answer Yes
• The study shows that there are definite
  anamnetic and objective findings as a basis for
  grommet insertion. There is an observation time
  of at least 3 months.

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Grommet treatment to children with SOM og AOM.
The study showed

• How the parents assess the grommet treatment of
  their child based on a bit softer quality values
  than normally measured upon.
• The parents assess that middle ear problems
  affect both the childs and the familys daily
  lives negatively to a great extent and that
  grommet insertion has resulted in a considerable
  improvement.

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Response to the hypotheses

• The practicing ENT specialists indication for
  grommet
• insertion is in agreement with the general
  guidelines issued by Danish specialists
• Standard 80 of the children are treated
  according to the recommendations in the
  arbitrarily selected guidelines.
• Indicator SOM observation time prior to
  grommet insertion.
• 2. The childrens social functioning
• The childs social functioning is assessed based
  on results from
• a questionnaire study to parents before and 3
  months after grommet
• treatment.
• 3. An improvement in the childs hearing can be
  objectively
• measured before and after surgery
• Middle ear pressure is measured by means of a
  tympanometer and oto-acoustic emissions (OAE) if
  possible, before and after grommet treatment.

YES
YES
YES
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Project group
Head of project, ENT specialist, associate
professor Ulf Schønsted-Madsen Nørregade 16 3.th
,5000 Odense C, ENT specialist Lotte Jung, PhD
Fisketorvet 4-6, 5. sal 5000 Odense C ENT
specialist Berit Svendstrup. Voldgade 9, 2. sal
5700 Svendborg
Dr. Anders Munck, GP, Head of Audit Project
Odense, consultant and data processing
External consultant Professor Karsten Jørgensen,
DMedSci Professor Jørgen Lous, DMedSci,
recommends the project.
The project received financial support from FAS
and Region Southern Denmark
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Questions and comments