14. Childhood elective treatments

Transcription

1 Childhood elective treatments 14.1 Drainage of the middle ear (OPCS4: D15) Over 70% of children have at least one episode of glue ear before they are four years old, resulting in short term hearing loss that can vary from mild to severe, and vary from day to day. In most cases hearing loss only lasts a short while; however, for some children hearing remains impaired. If glue ear persists, a small operation in the eardrum may be carried out, with fluid drained, and a grommet or pipe inserted to maintain drainage 66. Map 14.1 highlights geographic variations in elective treatment by drainage of the middle ear across the North West. The map indicates particularly high ratios in a group of Local Authorities to the north of Manchester, in particular within Bury, Rochdale, Rossendale, Oldham, Tameside, Salford and in north Manchester. Cumbria shows another broad area with higher than average ratios, in particular around the Barrow-in- Furness catchment area. Merseyside however, for example, shows particularly low ratios, relative to the region. As typically found for many health conditions, and for treatments, a gradient in the rate at which procedures are undertaken is apparent by social class for drainage of the middle ear, with rates of treatment increasing with deprivation level (Figure 14.1a). This linear relationship is still apparent by geodemographic lifestyle group, though less clear-cut, with Qualified Metropolitans, New Starters and Multicultural Centres lifestyle groups showing lower rates of treatment than neighbouring groups (Figure 14.1b). Treatment rates by predominant ethnic group show a different picture to many health events. Predominantly White and Pakistani areas have the highest treatment rates, with predominantly Chinese areas showing appreciably lower than average rates (Figure 14.1c). A mixed picture is shown in Figure 14.1d for urban and rural treatment rates. The North West Local Authorities with the highest hospitalised treatment ratios for drainage of the middle ear are Barrow-in- Furness (219), Bury (157) and Tameside (141); the lowest are Macclesfield (65), Warrington (68) and Trafford (75). As with drainage of the ear, a linear gradient in treatment rates for tonsillectomies is apparent (Figure 14.2a), with children in the most deprived regional quintile of population having procedure rates some 75% higher than those in the most affluent quintile, a wider range than that for drainage of the ear. Rates of treatment vary by geodemographic group (Figure 14.2b), though a gradual trend linked to deprivation levels is evident. Unlike drainage of the ear, predominantly Asian areas receive statistically significantly higher tonsillectomy treatment rates than do predominantly White and Black areas (Figure 14.2c). Urban populations receive higher rates of tonsillectomies (Figure 14.2d). The North West Local Authorities with the highest hospitalised tonsillectomy treatment ratio are Barrow-in-Furness (182), Hyndburn (160) and Oldham (139); the lowest are Eden (55), Lancaster (59) and Carlisle (66) Tonsillectomy (OPCS4: F34) The tonsils are lymph nodes in the back of the mouth/top of the throat, which help to filter out bacteria and other micro organisms, preventing infection 73. If they become overwhelmed by a bacterial or viral infection, the tonsils swell and become inflamed, causing tonsillitis. Where a child has had several significant spells of tonsillitis within a year, and suffers from enlarged tonsils that cause obstruction of swallowing or breathing, surgery may be recommended. Map 14.2 highlights geographic variations in tonsillectomy procedures across the North West region. Elective treatment by tonsillectomy demonstrates a different picture of regional activity to that of drainage of the ear. Again, a grouping of high ratios is seen around Barrow in Furness, along with higher ratios to the east of the region in areas such as Rochdale, Oldham and Tameside and north Manchester. In addition, parts of Wirral, coastal areas in and near Blackpool, and localities through Wigan, Bolton, Trafford, Hyndburn, Blackburn, for example, all show local higher than average ratio areas.

2 138 Figure 14.1: Hospitalised Elective Treatment by Drainage of the Middle Ear A B C D Key: Category North West

3 139 Map 14.1: Hospitalised Elective Treatment by Drainage of the Middle Ear

4 140 Figure 14.2: Hospitalised Elective Treatment by Tonsillectomy A B C D Key: Category North West

5 141 Map 14.2: Hospitalised Elective Treatment by Tonsillectomy