Consider if:

• hearing impairment
• indistinct speech or speech delay
• behavioural problems
• repeated ear infections or pain
• recurrent URTI or nasal obstruction

Important to check there is no other cause of hearing impairment.  Usually sufficient to monitor for 3/12.

Surgery only if bilateral and persistent, with impaired hearing or else significant impairment of learning or behaviour.

Nice guidance CG60, 2008