Overview of 2018 surveillance methods

NICE's surveillance team checked whether recommendations in otitis media with effusion in under 12s (NICE guideline CG60) remain up to date. The 2018 surveillance followed the static list review process, consisting of:

  • Feedback from topic experts via a questionnaire.

  • A search for new or updated Cochrane reviews and national policy.

  • A search for ongoing research.

  • Examining related NICE guidance and quality standards.

  • Examining the NICE event tracker for relevant ongoing and published events.

  • Consulting on the decision with stakeholders, except if we propose to update and replace the whole guideline.

For further details about the process and the possible update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.

Evidence considered in surveillance

Cochrane reviews

We searched for new Cochrane reviews related to the whole guideline. We found 9 relevant Cochrane reviews published between 1 June 2007 and 21 August 2018. The findings from the following Cochrane reviews indicate that recommendations should be updated:

The findings from the following Cochrane reviews support current recommendations:

  • The use of topical or systemic steroids for treating children with OME (Simpson et al. 2011).

  • The use of anti-histamines and decongestants for treating children with OME (Griffin et al. 2011).

Previous surveillance

Previous surveillance reviews in 2011 and 2014 concluded that an update was not necessary.

Related NICE guidance

NICE interventional procedures guidance on suction diathermy adenoidectomy, published in 2009 may be considered in the update of NICE guideline CG60 when evidence is considered on the use of adjuvant adenoidectomy to treat OME in children.

Ongoing research

We checked for relevant ongoing research. Of the ongoing studies identified, 2 studies were assessed as having the potential to change recommendations. We will share the details of these studies with the developers responsible for updating NICE guideline CG60 so that they can evaluate the impact of any published results. These studies are:

Intelligence gathered during surveillance

Views of topic experts

We sent questionnaires to 10 topic experts and received 5 responses. The topic experts were recruited to the NICE Centre for Guidelines Expert Advisers Panel to represent their specialty. Four topic experts indicated that the guideline should be updated and 1 indicated that it should not. Areas identified by topic experts that will be addressed in the update are:

  • The potential need for multiple ventilation tube insertions in children with recurrent hearing loss, and the insertion of ventilation tubes plus adjuvant adenoidectomy for children aged over 4 years who have recurrent OME and in those with significant nasal obstruction or infection. This was based on new evidence reported in the ICON on management of OME in children (Simon et al. 2018).

  • Additional information on non-surgical management of OME, such as further clarity on when to use autoinflation (age group and circumstances when it should be offered). This was based on new evidence reported in the ICON on management of OME in children (Simon et al. 2018).

  • Strengthening the recommendation on information for children, parents and carers, for example with regards to the effects on development for those with longer-term OME; and information on the possibility that children with hearing loss due to OME may have recurrent hearing loss following ventilation tube extrusion, which may mean a further new tube insertion is required, either using longer-stay tubes or considering adjuvant adenoidectomy.

The following areas were also highlighted by topic experts and may be considered in the update:

  • Risk factors for OME and how these can be managed, however this area is currently out of scope and no evidence was provided concerning risk factors or their management.

  • Assessing and treating hearing loss and recurrent ear infections in children with neurological or learning disabilities. However children with multiple complex needs were out of scope for the guideline because they will need individual and specific management of their overall condition by a multidisciplinary group of experts; and no evidence was provided concerning specific approaches for assessment or treatment of OME or hearing loss for this population.

A topic expert also requested that the NICE medtech innovation briefing on Otovent nasal balloon for otitis media with effusion, published in March 2016 should be cross-referenced within the recommendations in NICE guideline CG60. However this is already listed in the NICE Pathway on surgical management of otitis media with effusion in children, which brings together NICE guidance and supporting information on the topic from all of NICE's work programmes.

Views of stakeholders

Stakeholders are consulted on all surveillance proposals except if the whole guideline will be updated and replaced. Because this surveillance proposal was to update all of the guideline, we did not consult with stakeholders.


Topic experts noted that there is no guidance on considering the levels of hearing loss in context of the child, particularly in children with neurological or learning difficulties with whom routine audiology may be difficult and lead to delayed intervention.

Editorial amendments


Overall decision

After considering all evidence and other intelligence and the impact on current recommendations, we decided that an update is necessary.

ISBN: 978-1-4731-3187-3

This page was last updated: 12 December 2018