1. ENT Procedures of limited clinical value?

2. Several PCTs have lists NHS Bradford and Airedale doesn't ENT related conditions that are included are: – Tonsillectomy and adenoidectomy – Grommets – snoring

4. Tonsillectomy SIGN guidance 2010 HSJ report 2010 Cochrane 2009

5. Sore throats are due to tonsillitis Episodes are disabling and prevent normal functioning (missing work or school etc) 7 or more well documented, clinically significant sore throats in the preceding year 5 or more such episodes in each of the preceding 2 years 3 or more such episodes in each of the preceding 3 years Is frequency decreasing or increasing? HSJ report – increased admissions over last few years

6. Grommets NICE guidance 2008 and 2000 Cochrane review 2005

7. Background >50 % glue ear resolves by 3/12 >80% resolves at 9/12 Grommets improving hearing on a PTA Little long term evidence that they effect development Varying impact of glue ear on each individual

8. NICE 2008 Hearing assessment Watch and wait Reassess at 3 months Consider Grommets if persistent hearing loss >25dB in the worse ear

9. Management in primary care Clinical history and examination Tympanogram and PTA School nurse