titis media and associated hearing loss are highly prevalent in Indigenous Australian children. 1 Most relevant prevalence studies have been undertaken in rural and remote regions, although most Indigenous children live in urban areas. 2 One prospective cohort study found that hearing loss was frequent in young Aboriginal children in a semi-arid zone of Western Australia, 3 but its prevalence in Aboriginal infants in urban areas has not been investigated. 4 We therefore estimated the prevalence of hearing loss in Aboriginal infants in Perth, Western Australia, enrolled in the Djaalinj Waakinj cohort study (2017-2021), 5 and examined the association between otitis media and hearing responses.

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Aim Australian Aboriginal and/or Torres Strait Islander children in rural/remote areas suffer high rates of persistent otitis media (OM) from early infancy. We aimed to determine the proportion of Aboriginal infants living in an urban area who have OM and investigate associated risk factors. Methods Between 2017 and 2020, the Djaalinj Waakinj cohort study enrolled 125 Aboriginal infants at 0–12 weeks of age in the Perth South Metropolitan region, Western Australia. Proportion of children with OM based on tympanometry at ages 2, 6 and 12 months was evaluated, type B tympanogram indicating middle ear effusion. Potential risk factors were investigated by logistic regression with generalised estimating equations. Results The proportion of children with OM was 35% (29/83) at 2 months, 49% (34/70) at 6 months and 49% (33/68) at 12 months of age. About 70% (16/23) of those with OM at ages 2 and/or 6 months had OM at 12 months compared with 20% (3/15) if no prior OM (relative risk = 3.48, 95% confidence interval (CI): 1.22–40.1). On multivariate analysis, infants living in houses with ≥1 person/room were at increased risk of OM (odds ratio = 1.78, 95% CI: 0.96–3.32). Conclusion Approximately half of Aboriginal infants enrolled into the South Metropolitan Perth project have OM by the age of 6 months and early onset of disease strongly predicts subsequent OM. Early surveillance for OM in urban areas is needed for early detection and management to reduce the risk of long‐term hearing loss which can have serious developmental, social, behavioural, educational and economic consequences.