Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross-sectional survey

Abstract

BackgroundMiddle ear disease (otitis media) is common and frequently severe in Australian Aboriginal children. There have not been any recent large-scale surveys using clear definitions and a standardised middle ear assessment. The aim of the study was to determine the prevalence of middle ear disease (otitis media) in a high-risk population of young Aboriginal children from remote communities in Northern and Central Australia.Methods709 Aboriginal children aged 6–30 months living in 29 communities from 4 health regions participated in the study between May and November 2001. Otitis media (OM) and perforation of the tympanic membrane (TM) were diagnosed by tympanometry, pneumatic otoscopy, and video-otoscopy. We used otoscopic criteria (bulging TM or recent perforation) to diagnose acute otitis media.Results914 children were eligible to participate in the study and 709 were assessed (78%). Otitis media affected nearly all children (91%, 95%CI 88, 94). Overall prevalence estimates adjusted for clustering by community were: 10% (95%CI 8, 12) for unilateral otitis media with effusion (OME); 31% (95%CI 27, 34) for bilateral OME; 26% (95%CI 23, 30) for acute otitis media without perforation (AOM/woP); 7% (95%CI 4, 9) for AOM with perforation (AOM/wiP); 2% (95%CI 1, 3) for dry perforation; and 15% (95%CI 11, 19) for chronic suppurative otitis media (CSOM). The perforation prevalence ranged from 0–60% between communities and from 19–33% between regions. Perforations of the tympanic membrane affected 40% of children in their first 18 months of life. These were not always persistent.ConclusionOverall, 1 in every 2 children examined had otoscopic signs consistent with suppurative ear disease and 1 in 4 children had a perforated tympanic membrane. Some of the children with intact tympanic membranes had experienced a perforation that healed before the survey. In this high-risk population, high rates of tympanic perforation were associated with high rates of bulging of the tympanic membrane.

Survey Analysis for Indigenous Policy in Australia: Social Sciences Perspectives (CAEPR Monograph 32)

“…Previous studies have highlighted that hearing loss and impediments are more prevalent among Indigenous children (ABS 2006), particularly in more remote communities with poor environmental health conditions (Coates et al 2002;Zubrick et al 2004). Middle ear infection, or otitis media, is a persistent problem in many Indigenous communities and is regarded as the most common cause of hearing impediments among Indigenous children (Morris et al 2005).…”

Reports indicate that changes are needed to close the gap for Indigenous health

“…The levels described among children living in some remote communities in northern and central Australia are such that they would be classified by the WHO as being 'a massive public health problem' requiring 'urgent attention' [163, p.2]. In 2001, nearly all children (91%) aged 6-30 months living in some remote communities in the NT and central Australia had been diagnosed with some form of OM [162]. 17 The report defined endemic trachoma as a prevalence of active trachoma of more than 5% in children aged 5-9 years.…”

“…Prevalence Exceptionally high levels of ear disease and hearing loss have been reported for many years in many Indigenous communities, particularly in remote areas [158,[160][161][162]. The levels described among children living in some remote communities in northern and central Australia are such that they would be classified by the WHO as being 'a massive public health problem' requiring 'urgent attention' [163, p.2].…”

“From your own thinking you can't help us”: Intercultural collaboration to address inequities in services for Indigenous Australians in response to the World Report on Disability

“…For example, a survey of young Aboriginal children in Northern and Central Australia found that 91% were affected by otitis media (Morris, Leach, Silberberg, Mellon, Wilson, Hamilton, et al, 2005). Extensive testing of Aboriginal children was also conducted through the Child Health Check Initiative (CHCI) introduced under the Northern Territory Emergency Response (NTER), which found that 30% had ear disease (Australian Institute of Health and Welfare and Department of Health and Ageing, 2009).…”