How an Advanced Audiology‑Led Model Transformed Access to Grommet Surgery in South Auckland

For many families, getting a child seen for chronic ear infections or hearing problems can feel like an endless wait. Otitis media — middle ear disease — is incredibly common in childhood, but accessing timely treatment, especially grommet surgery, has long been a challenge in Aotearoa New Zealand.

A new study from Counties Manukau shows that an advanced audiology‑led model of care can dramatically improve access, reduce wait times, and deliver safe, effective treatment for children who need it most.

Here’s what the research found.

Why Otitis Media Matters

Otitis media affects up to 80% of children by age three. While serious complications are rare in high‑income countries, the most common consequence is hearing loss — which can impact:

• Speech and language development

• Learning and school performance

• Attention and behaviour

• Long‑term cognitive outcomes

For Māori and Pacific children, the burden is even higher. They experience more frequent and severe ear disease, face greater barriers to primary care, and are more reliant on overstretched public hospital services.

Counties Manukau, home to large Māori and Pacific communities, has long struggled with long waits for paediatric ORL (ENT) appointments and grommet surgery.

A New Solution: The Advanced Audiology Practitioner (AAP) Service

To address these challenges, Counties Manukau introduced an Advanced Audiology Practitioner (AAP) model — an extended‑scope audiology service designed to:

✅ Reduce wait times

✅ Improve access to treatment

✅ Prioritise children at highest risk

✅ Reduce pressure on ORL specialists

Audiologists with advanced training assessed children directly from the ORL waitlist, performed full diagnostic testing, managed conservative care, and — crucially — could directly waitlist children for grommet surgery after virtual review by an ORL consultant.

This is the first model of its kind reported in New Zealand.

What Happened When the AAP Service Launched?

1. Capacity skyrocketed

The AAP service delivered 12 first specialist appointments (FSAs) per week, compared to the previous ORL average of 7.3 per week — a 161% increase in capacity for ear‑related referrals.

2. Long waits dropped dramatically

Before the AAP model, 45% of children were waiting longer than 120 days.After three months, this dropped to:

• 30% for all paediatric ORL referrals

• 27% for ear‑related referrals

3. Wait times plummeted

Children seen early in the trial had waited an average of 196 days.By the end of the study, the wait was just 14 days.

This improvement was seen across all ethnic groups.

4. Families showed strong engagement

• 96% attended their first AAP appointment

• Attendance was high across all ethnicities

• Follow‑up attendance was lower, especially for Māori and Pacific children — highlighting ongoing barriers beyond the clinic itself

A kaimanaaki (patient navigator) service supported Māori whānau, helping with communication, transport, and appointment preparation.

What Did the AAP Service Achieve Clinically?

Efficient care

• 55% of children were fully managed in one appointment

• Only 9% needed onsite ORL review

• The model saved 141 ORL appointments over three months

High surgical accuracy

Of the children waitlisted for grommets:

• 91% had middle ear effusion confirmed at surgery

• Only 8.7% had clear ears on the day — an excellent accuracy rate for surgical decision‑making

Surgical conversion rate

• 45% of children seen in AAP were waitlisted for grommets

• No significant differences across ethnic groups

Addressing wider needs

Nearly 20% of children required additional referrals for:

• Speech‑language therapy

• Developmental assessment

• Healthy lifestyle programmes

• Hearing devices or swim plugs

This highlights the value of audiologists taking a holistic, child‑centred approach.

Why This Model Matters

The AAP service shows that audiologists with extended scopes can:

✅ Dramatically reduce wait times

✅ Improve equity of access

✅ Deliver safe, accurate clinical decisions

✅ Reduce pressure on ORL specialists

✅ Provide culturally responsive care with the support of kaimanaaki services

For communities like Counties Manukau — where ear disease is common and ORL capacity is limited — this model offers a powerful, scalable solution.

The Bottom Line

The advanced audiology‑led model didn’t just tweak the system — it transformed it.

By shifting appropriate care to highly trained audiologists, children received faster assessment, quicker access to surgery, and more equitable care. ORL specialists were reed to focus on complex cases, and families avoided unnecessary delays and extra appointments.

This study provides strong evidence that extended‑scope audiology services can play a central role in improving ear health outcomes for children in Aotearoa — especially those who have historically faced the greatest barriers.

If you would like to read more Pokorny, M. A., Hislop, R. A., Johnston, J., Wong, J., & Mahadevan, M. (2025). Audiology-led model provides efficient and effective access to grommet surgery. Journal of the Royal Society of New Zealand, 55(3), 596–610. https://doi.org/10.1080/03036758.2024.2344773