Ear conditions
Ear conditions
Ear infections are the most common type of illness in babies and
young children, and three out of four children experience some form
of otitis media (OM) by the time they are 3 years of age [1].
OM, which often occurs as a result of another illness (involving
viruses or bacteria or both), is a common disorder in both developed
and developing countries [2], but its form, onset,
and natural history vary from population to population [3].
In developed countries, OM with effusion is prevalent and considered
a major problem. In contrast, in developing countries acute and
chronic suppurative forms of OM are much more common [4].
The pattern of OM observed among many Indigenous communities differs
from that typically observed in the developed world, being more
similar to that seen among disadvantaged populations in developing
countries [5]. The high prevalence of OM among
Aboriginal people is well established, and suppurative OM is of
greatest concern.1
OM, particularly suppurative forms, is associated with some impairment
of hearing, with major implications for language development and
learning difficulties [4, 6].
The risk of permanent hearing loss increases if OM is not adequately
treated and followed up. The hearing impairment associated with
OM is generally conductive in nature2 and mild to moderate in degree,
and may be intermittent or persistent depending on the middle-ear
condition present at the time [4, 7].
Extent of ear disease among Indigenous people
The level of ear disease and hearing loss among Indigenous people
remains higher than that of the general Australian population, particularly
among children and young adults [4, 8].
In the 2001 NHS, Indigenous people reported more ear and hearing
problems (18%) than did non-Indigenous people (14%) with an increasing
prevalence with age [9]. Importantly, the proportions
of young people with ear and hearing problems were much higher for
Indigenous than non-Indigenous people: 11% compared with 5% for
people aged 0-14 years and 13% compared with 5% for those aged 15-24
years.
The more detailed information collected by the WAACHS reveals that
18% of Indigenous children aged 0-17 years had recurring ear infections
[10]. Children 0-11 years were more likely (20%)
to have recurring ear infections than children aged 12-17 years
(14%). Abnormal hearing was reported by carers for 7% of the children
aged 4-17 years. Of children with recurring ear infections with
discharge, 28% had abnormal hearing compared with 1% of those without
ear infections.
These differences are not fully reflected in overall hospitalisation
rates for ear and hearing problems, which were similar for Indigenous
and non-Indigenous people in 2000-01 [11].3 There
were, however, more separations for Indigenous people (67%) due
to otitis media than for non-Indigenous people (60%). For Indigenous
hospitalisations, a further 14% were for ear problems due to perforation
of the tympanic membrane (compared with 7% for non-Indigenous people).
As is the case with knowledge about most specific health conditions,
the most valuable information about ear disease comes from specific
studies, which have found particularly high levels of OM among Indigenous
people living in rural and remote communities and lower levels for
those living in urban areas (see [8] for a detailed
review of the various studies). OM can affect Indigenous babies
within weeks of birth and a high proportion of children will continue
to suffer from CSOM throughout their developmental years [12].
Individual studies have documented very high levels of CSOM in some
Indigenous communities. The WHO has identified a prevalence of CSOM
of greater than 4% as being ‘a massive public health problem’
requiring ‘urgent attention’ [13,
p.29]: some Indigenous communities had a prevalence up to 10 times
higher than this [6, 14].
The higher levels of OM that Indigenous people experience in their
childhood years are reflected in a higher frequency of hearing loss,
which have been documented in numerous studies (see [8]
for a detailed review of the studies).
As with many other areas of Indigenous health, this massive public
health problem will be solved ‘only with urgent attention
to improving housing and access to running water, nutrition and
quality of care, and giving communities greater control over these
improvements’ [6, p.178]
References
1 National Institute on Deafness and other
Communication Disorders (NIDCD) (2003) What is otitis media?
Retrieved 6 May 2003 from http://www.nidcd.nih.gov/health/hearing/otitismedia.asp#whatis
2 Boswell J, Nienhuys T (1995) Onset of otitis
media in the first eight weeks of life in Aboriginal and non-Aboriginal
Australian infants. Annals of otology, rhinology, and laryngology;104:542-549
3 Boswell JB, Nienhuys TG, Rickards FW, Mathews
JD (1993) Onset of otitis media in Australian Aboriginal infants
in a longitudinal study from birth. Australian Journal of Otolaryngology;1:232-7
4 Couzos S, Metcalf S, Murray R (2003) Ear
health. In: Couzos S, Murray R, eds. Aboriginal primary health
care: an evidence-based approach. 2nd ed. South Melbourne:
Oxford University Press:193-250
5 Leach AJ, Boswell JB, Asche V, Nienhuys
TG, Mathews JD (1994) Bacterial colonization of the nasopharynx
predicts very early onset and persistence of otitis media in Australian
Aboriginal infants. Pediatric Infectious Disease Journal;13:983-9
6 Coates HL, Morris PS, Leach AJ, Couzos
S (2002) Otitis media in Aboriginal children: tackling a major health
problem [editorial]. Medical Journal of Australia;177(4):177-178
7 Morris P (1998) A systematic review of
clinical research addressing the prevalence, aetiology, diagnosis,
prognosis and therapy of otitis media in Australian Aboriginal children.
[review]. Journal of Paediatrics and Child Health;34(6):487-497
8 Burrow S, Thomson N (2003) Ear disease
and hearing loss. In: Thomson N, ed. The health of Indigenous
Australians. South Melbourne: Oxford University Press:247-272
9 Australian Bureau of Statistics (2002)
National Health Survey: Aboriginal and Torres Strait Islander
results, Australia 2001. (ABS Catalogue no. 4715.0) Canberra:
Australian Bureau of Statistics
10 Zubrick SR, Lawrence DM, Silburn SR,
Blair E, Milroy H, et al. (2004) The Western Australian Aboriginal
Child Health Survey: the health of Aboriginal children and young
people. Perth: Telethon Institute for Child Health Research
11 Australian Bureau of Statistics, Australian
Institute of Health and Welfare (2003) The health and welfare
of Australia's Aboriginal and Torres Strait Islander peoples 2003.
(ABS Cat no.4704.0, AIHW Cat no. IHW11) Canberra: Australian Bureau
of Statistics
12 Couzos S, Metcalf S, Murray RB (2001)
Systematic review of existing evidence and primary care guidelines
on the management of otitis media in Aboriginal and Torres Strait
Islander populations. Canberra: Commonwealth Department of
Health and Aged Care
13 World Health Organization and Ciba Foundation
(1998) Prevention of hearing impairment from chronic otitis
media. Report of WHO/CIBA Foundation Workshop. London, 19-21 November
1996. Retrieved 11 July 2003 from http://www.who.int/pbd/deafness/en/chronic_otitis_media.pdf
14 World Health Organization (2004) Chronic
suppurative otitis media: burden of Illness and management options.
Retrieved 5 November 2004 from http://www.who.int/child-adolescent-health/New_Publications/CHILD_HEALTH/ISBN_92_4_159158_7.pdf
Endnotes
1 As with all areas of Indigenous health,
there is considerable diversity in the impact of ear disease among
Indigenous people across Australia. In particular, ear disease has
not been identified as a major problem among Torres Strait Islander
people. The patterns described in this section do not apply to all
Indigenous people, but they are characteristic for many Indigenous
communities, particularly those in remote parts of the country.
2 Some literature suggests that chronic
discharge may lead also to sensorineural hearing loss [4].
Sensorineural hearing loss is permanent and is commonly caused by
nerve damage that impedes the transmission of sound from the inner
ear to the brain. When conductive and sensorineural hearing loss
coexist, the hearing loss is referred to as ‘mixed’.
3 As noted in the section entitled ‘Hospitalisation’,
it is likely that the Australia-wide numbers and rates under-estimate
Indigenous hospitalisation by as much as 25%.
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