3.2 Myringotomy hospitalisations, 17 years and under

Myringotomy is one of the most common surgeries done in young children. It is used to treat middle ear infections (otitis media), which can cause hearing loss. Most children with otitis media do not require surgery and watchful waiting is recommended, but in some cases, myringotomy with grommets is the most effective option.   

Aboriginal and Torres Strait Islander children have the highest rates of middle ear disease in the world. These children are at risk of earlier, more severe and longer-lasting middle ear disease than non-Indigenous children. Hearing loss at an early age can cause serious educational and social problems.

The First Atlas 2015 found wide variation in myringotomy hospitalisations. The Fourth Atlas 2021 shows trends over time.

In 2017–18:

• There were 34,755 hospitalisations for myringotomy, representing 600 hospitalisations per 100,000 people aged 17 years and under (the Australian rate)
• The number of hospitalisations for myringotomy across 314 local areas ranged from 198 to 1,607 per 100,000 people aged 17 years and under
• The rate was 8.1 times as high in the area with the highest rate compared with the area with the lowest rate
• The rate for Aboriginal and Torres Strait Islander children was 6% higher than the rate for other Australian children. This is less than what would be expected if every Aboriginal and Torres Strait Islander child who needed myringotomy had the surgery
• 68% of myringotomy hospitalisations were for privately-funded patients.

Between 2012–13 and 2017–18:

• The overall rate of myringotomy hospitalisation decreased by 4% nationally
• For Aboriginal and Torres Strait Islander children, the rate of myringotomy hospitalisation increased by 30%.

Rates are standardised to remove age and sex differences between populations.

Aboriginal and Torres Strait Islander children have a higher burden of middle ear disease. The rate of myringotomy hospitalisations has increased over time in Aboriginal and Torres Strait Islander children, but it still does not match the higher burden of disease. This means that not all Aboriginal and Torres Strait Islander children who need myringotomy receive it. Conversely, some non-Aboriginal or Torres Strait Islander children may be having myringotomy when they do not need it.

Variation in rates of myringotomy is likely to be due to differences in:

• Rates of disease – rates are higher in Aboriginal and Torres Strait Islander children, but are still not high enough to match their higher rate of middle ear disease
• Clinical decision-making – current Australian guidelines are for Aboriginal and Torres Strait Islander children only. Differences in application of these guidelines could contribute to variation in rates
• Parents’ choice – some parents may push for their child to have surgery rather than watchful waiting. Aboriginal and Torres Strait Islander parents may feel less empowered to ask about surgery if services are not culturally safe
• Clinical factors – GPs may over-diagnose or under-diagnose middle ear infection
• Access to audiology services – access to these services may affect the early detection of otitis media, and rates of surgery
• Access to myringotomy services – ear, nose and throat specialists are less available in rural and remote areas. Aboriginal and Torres Strait Islander people may not have good access to culturally appropriate care
• Private health insurance – private patients may have a shorter waiting time than public patients.

Improve prevention, diagnosis and treatment of middle ear disease in Aboriginal and Torres Strait Islander children. This should use a comprehensive community approach.

Make sure that children who need myringotomy receive it by:

• Improving ear health monitoring
• Improving diagnostic training
• Updating guidelines
• Improving access to hearing support services, including audiologists
• Improving access to ear, nose and throat specialists
• Supporting shared decision making
• Improving data collection.

The Commission consulted widely, but is solely responsible for making the recommendations; as such, the recommendations may not reflect the views of all contributors to the Atlas.

3c. State and territory health departments and health service organisations to set benchmarks for access to paediatric audiology services.

3d. The Australian Government Department of Health to develop and implement two national ear and hearing health performance indicators for Aboriginal and Torres Strait Islander children consistent with the recommendations of the National Aboriginal and Torres Strait Islander Hearing Health Advisory Panel:

i. Measure the proportion of Aboriginal and Torres Strait Islander children who received an annual ear and hearing health check and the proportion of these who were found to have ear and/or hearing health conditions 

ii. Measure the proportion of Aboriginal and Torres Strait Islander children who received audiology services and the proportion of these diagnosed with hearing loss.

3e. The Australian Government Department of Health, as part of the Roadmap for Hearing Health, to publish data on progress against the integrated national approach to undertaking ear health checks of children aged 0–6, with the goal of every Aboriginal and Torres Strait Islander child having regular ear health checks.

3f. Health service organisations to:

i. Conduct audits of myringotomy and myringotomy rates to monitor variation and provide the results back to clinicians to act upon in line with Action 1.28 of the NSQHS Standards

ii. Incorporate individual clinician’s audit data as part of recredentialing processes

Download the myringotomy hospitalisations section of the Atlas to read more about context, data, key findings, interpretation and addressing variation:

Contents:

Context

• Place of myringotomy in therapy
• Otitis media with effusion
• Acute otitis media
• What are the potential harms?
• Preventing otitis media
• Why revisit variation in myringotomy?

About the data

What do the data show?

• Magnitude of variation
• Analysis by remoteness and socioeconomic status
• Analysis by Aboriginal and Torres Strait Islander status
• Analysis by patient funding status
• Trends over time

Interpretation

• Rates of underlying disease
• Clinical decision-making
• Parents’ preferences
• Diagnostic skills and training
• Access to audiology services
• Access to myringotomy services
• Rates of private health insurance and waiting times

Addressing variation

• Interventions to improve prevention, diagnosis and treatment of otitis media in Aboriginal and Torres Strait Islander communities

Resources

Australian initiatives

• Roadmap for Hearing Health
• Clinical guidelines
• Vaccination
• Hearing support
• Shared decision making
• Diagnosis and treatment for Aboriginal and Torres Strait Island children
• Queensland's Deadly Ears Program
• ENT surgical registry
  
   

References