Doubt over savings from restricting ear treatment

A leading surgeon doubts the Government will be able to save money by cutting down on treating children's ears with grommets.

Scott Stevenson, an ear, nose and throat surgeon, was commenting on a government group's suggestion New Zealand could save $4.4 million a year if its rate of grommet insertion was lowered to Britain's level.

"The savings probably aren't there," said Mr Stevenson, the chairman of the New Zealand board of the Royal Australasian College of Surgeons.

The National Health Committee, which is responsible to Health Minister Tony Ryall, is trying to find $30 million of savings in the public health system for reinvestment in more effective or better-targeted treatments.

It has looked at a British list of 550 "relatively low priority" elective surgical procedures and said New Zealand spent $641 million a year on the "top 25" of those. It will not name the 25 procedures, but has analysed the use of grommets.

Grommets are tiny tubes placed in an incision in the eardrum. They are used to treat recurrent acute middle-ear infections and ongoing glue ear. The two conditions usually coexist and both involve fluid behind the eardrum.

Acute middle-ear infections can cause severe pain, fever, grumpiness and interrupted sleep. Glue ear may have few symptoms, although ear pain may occur and hearing loss is common, sometimes enough to delay speech and language development. Glue ear can impair balance, too.

Grommet insertion, which carries some risks, would not normally be considered unless a child had had four acute episodes in six months, or six in a year - or until after three to six months' monitoring of glue ear and evidence of hearing loss.

Mr Stevenson said the college had concerns about the ideas the National Health Committee expressed on grommets in a discussion document and he had responded "fairly vigorously".

The ideal intervention rate for grommets was unknown.

"No one has looked at that and said are we over-treating or is the UK under-treating.

"Maori and Pacific people have a high incidence of middle-ear disease. I would hate to see anything done that impacts on our ability to look after some of our most economically deprived and underprivileged kids."

Auckland ear, nose and throat surgeon Dr Colin Brown said, "The UK is not a good reference point in terms of whether we do more or less. In my opinion children are substantially under-treated in the UK."

He said that in the past 10 years, New Zealand specialists had become "much more conservative" about inserting grommets.

Mr Stevenson said the college was collaborating to write national guidelines for treating ear infections and later a survey of intervention rates would be done.

Labour's health spokeswoman, Maryan Street, said reducing the number of grommet operations for children - without a direct investment in measures to reduce the need for the treatment - would be a false economy that led to "more kids sitting in class unable to listen and learn".

- Martin Johnston of the New Zealand Herald