Reimagining grommet follow-up care: audiology-led outcomes and cost comparison with ENT (Ear, Nose and Throat) and nurse-led models

Grommet insertion is one of the most common surgeries in childhood. While post-operative care has been traditionally provided by Ear, Nose and Throat (ENT) specialists, workforce capacity challenges have led to the delegation of care to alternate workforces, including audiology. This study aims to evaluate safety and effectiveness of audiology-led post-grommet services and to compare costs of audiology-led models with traditional medical and simulated nurse-led models. A retrospective cohort study was conducted in a regional New Zealand public hospital including all 247 children attending an audiology-led post-grommet clinic from 2019 to 2025. Patient outcomes and pathways through post-grommet services were mapped and costs to the healthcare system and patient/families were calculated. 42.5% of children required an ENT assessment following the implementation of an audiology-led post-grommet model. At the first post-operative visit (median 184 days) 57.5% of grommets were nonfunctional. There were no adverse events reported over the six-year study period. Average healthcare system cost per patient was $NZ130.40 for the audiology-led model representing a 12% cost-savings compared to the standard ENT model ($NZ147.85). The simulated nurse-led model was more costly compared to the audiology-led and ENT models. Cost-savings for patients were achieved through salary differences and fewer clinic visits required under the audiology-led model compared to standard care. Audiology-led post-grommet models are a clinically appropriate and cost-efficient approach to optimise service delivery in resource-limited settings.