In paediatrics the question is almost never “should we operate”, it is “what does the operation improve, and for how long”. Grommets gain 12 dB at 3 months and nothing at 12. Bracing keeps 72 percent of adolescents below the surgical threshold, but only if it is worn. Only three screens carry an established net benefit in an asymptomatic child. All three findings come from randomised trials, not from opinion.
The questions we get asked
Should grommets be inserted for glue ear?
The hearing benefit is real, early and transient: 12 dB at 3 months, 4 dB between 6 and 9 months, no difference at 12 and 18 months. On language and school learning, a cohort followed to age 11 found no difference across 48 measures. The 2022 US guideline asks for a hearing assessment if effusion persists for at least 3 months, and does not recommend insertion for a shorter isolated episode.
When is tonsillectomy justified?
The recommended numeric threshold is 7 episodes in the past year, 5 per year over two years, or 3 per year over three years. Below that, watchful waiting is recommended with a strong evidence grade, and in the least affected children surgery does worse than abstention in the first year.
Does a scoliosis found on screening mean surgery?
Rarely. Across 2.8 million children screened, 0.33 percent exceed 20 degrees and 0.02 percent exceed 40. Bracing has a demonstrated effect, with a number needed to treat of 3, and its condition of effectiveness is actual wear time.
Is a routine check-up useful in a well child?
Only three screens have an established net benefit: newborn hearing, vision between 3 and 5 years, and obesity from age 6 provided the child is referred to an intensive behavioural intervention. Universal hip ultrasound doubles the treatment rate without significantly reducing late dislocations.
What the figures say
| Finding | Figure | Source |
|---|---|---|
| Hearing gain from grommets at 3 months, then at 12 months | 12 dB, then no difference | Cochrane, 2010 |
| Language and cognition difference at 9 to 11 years | none across 48 measures | Paradise et al., 2007 |
| Bracing success against observation | 72 against 48 percent | BrAIST, 2013 |
| Adolescents exceeding 40 degrees | 0.02 percent | Lam et al., Spine, 2026 |
| Paediatric screens with established net benefit | 3 | USPSTF |
| Unoperated children who normalised spontaneously, sleep apnoea | 46 percent at 7 months | CHAT, N Engl J Med, 2013 |
What Noria Health does, and does not do
We organise a specialist paediatric consultation near Brussels, ENT, spinal orthopaedics or a structured assessment depending on the question, and we confirm feasibility within 24 to 48 hours. Follow-up is documented at D14, D30 and D90.
We do not set any surgical indication remotely, we do not interpret an investigation by message, and we never recommend postponing or interrupting care already under way.
Who reviewed this page
Noria Health editorial team.
Our paediatrics articles
- Glue ear: grommets gain 12 dB at 3 months and nothing at 12
- Adolescent scoliosis: bracing works, if it is actually worn
- Child health checks: only three screens have established benefit
- Children: when a persistent symptom deserves a second opinion
Have your case reviewed. Noria Health arranges a specialist consultation near Brussels and confirms feasibility within 24 to 48 hours. Open a case.