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Development of the Indigenous EarInfoNet is being undertaken by the Australian Indigenous HealthInfoNet in partnership with Menzies School of Health Research. Its development is being guided by a national Reference Group and the Indigenous EarInfoNetwork, an informal national network of people working in the field of Indigenous ear health and hearing.
Funding for the Indigenous EarInfoNet is provided by the Office for Aboriginal and Torres Strait Islander Health (OATSIH). Other support is provided by Edith Cowan University. (The Pratt Foundation and the Cooperative Research Centre for Aboriginal Health provided initial funding to get the project underway, Variety, the Children's Charity facilitated access to funding from the Pratt Foundation.)
Development of the EarInfoNet recognises the urgent need to improve approaches to otitis media and hearing loss, which are serious public health problems for Indigenous Australians. According to the World Health Organization, rates of ongoing middle ear infection with eardrum perforation and discharge (chronic suppurative otitis media) that affect more than 4% of the population represent a serious public health problem. In some remote Indigenous communities, rates of ear drum perforation exceed 60%, and up to 50% of children have been found to have educationally significant hearing loss and would benefit from sound amplification. Some Indigenous children have pus discharging from their ears for years. This impairs hearing in the short term, and affects essential early childhood development (particularly speech development). It can also lead to permanent hearing loss if parts of the middle ear and ear drum are damaged. Hearing loss can affect a child's education and social relationships, and even job opportunities in adulthood. The reasons for the very high rates of ear disease are complex, but include poverty, poor housing, overcrowding and an over-stretched health care-system.
There is a large body of knowledge about how best to prevent, diagnose, treat and manage middle ear disease and associated communication and learning problems, but many people involved in the area of Indigenous ear health, hearing and education work in remote areas of Australia and do not have ready access to good quality information and resources.
The EarInfoNet: includes reviews; guidelines; resources and equipment; programs, projects and lessons; policies and strategies; publications; and links. It also includes information about research activity, funding opportunities, organisations, agencies and individuals working in the field, news and events and training programs.
The resource has been designed to cater to an audience of mixed cultural and educational backgrounds. Some people will not have ready access to the Internet and so the resource will actively encourage the downloading of material for use by Indigenous families and communities.
Development of this web resource and the associated yarning place is guided by a national reference group. The EarInfoNet Reference Group, comprising people working as practitioners, and/or researchers in the area of ear health and hearing among Indigenous peoples, provides advice on:
Members of the EarInfoNet Reference Group are:
Associate Professor Peter Morris (Chair)
Associate Professor Peter Morris has worked at the Menzies School of Health Research since 1994. He has participated in a number of research projects that have aimed to improve medical management of otitis media in rural and remote Aboriginal children across the Northern Territory (NT). He is also a paediatrician at the Royal Darwin Hospital and conducts clinics at remote communities on the Tiwi Islands. He is an Associate Professor and Clinical Epidemiologist at the NT Clinical School, Flinders University. He is a strong advocate for evidence-based medicine and the application of randomised controlled trials to address important health problems. He has been a reviewer with the Cochrane Collaboration since 1996 and an editor with the Acute Respiratory Infections Group since 2000.
Judith Boswell PhD
Dr Judith Boswell is a Director of Adelaide Hearing Consultants (AHC), a private audiology consultancy based in South Australia. Judith trained first as a speech pathologist then as an audiologist, graduating from Melbourne University in 1984. Her first position was with the Health Department of Victoria.
From 1989, Judith was employed as Research Audiologist with the Menzies School of Health Research in Darwin. During her five years there, she undertook research into middle ear infection and hearing loss in Indigenous Australians. She received her PhD from the University of Sydney in 1994 for her research work with Aboriginal infants. Judith has published her Indigenous ear health research findings in national and international journals and presented her work at conferences both in Australia and overseas.
From 1994-1998, Judith planned and coordinated the first Master in audiology course to be offered at the Flinders University of South Australia. In 1999-2000, Judith left Adelaide to manage the Ear, nose and throat outreach project, based in Cairns. This pilot project delivered surgical and audiological services and training to remote Indigenous communities in Cape York, the Gulf of Carpentaria and the Torres Strait.
In 2000, Judith returned to Adelaide to manage a private audiological consultancy and clinical practice which provides diagnostic and rehabilitative hearing services to adults and children.
Judith has more than 20 years of experience providing training in issues related to middle ear disease and associated hearing loss for Indigenous and non-Indigenous health personnel in remote communities in New South Wales (NSW), the Northern Territory (NT) and Western Australia and contributing to the Commonwealth intervention in remote Aboriginal communities in the NT and the Closing the gap initiative.
Judith has delivered teaching and clinical supervision in the field for the Certificate of community audiometry for Aboriginal Health Workers, TAFE NSW, the Child ear health, hearing and learning course (designed by the Northern Territory Aboriginal hearing program, Aboriginal Medical Services Alliance of the Northern Territory and NT Hearing Services) and the University of Queensland's Bachelor of applied science (Indigenous primary health care) degree. In 2011, she was employed to write an online training module in Indigenous ear and hearing health for the Remote Area Health Corps, NT.
Judith was made a Fellow of the Audiological Society of Australia in 2009, in recognition of her contributions to Indigenous hearing health and to audiology education.
Clinical Professor Harvey Coates AO
Dr Harvey Coates AO MS FRC(C) FRACS DABO is a Paediatric Otolaryngologist and Clinical Professor at the University of Western Australia, School of Paediatrics and Child Health and University Department of Otolaryngology, Head and Neck Surgery, and Senior Ear Nose and Throat Head and Neck Surgeon (ENT Surgeon) at Princess Margaret Hospital for Children.
He is Chairman of the Aboriginal Sub-committee of the Australian Society of Otolaryngology Head and Neck Surgery. His current research interests are the relationship of bacterial biofilms to otitis media, chronic rhinosinusitis and adenoid disease, obstructive sleep disorder and newborn hearing screening, and Indigenous children's ear disease.
Dr Coates was appointed an Officer of the Order of Australia in 2005 for his work and research in paediatric otolaryngology and ear disease in Aboriginal children. He has also won several other awards including the Deafness Council WA Inc. Dr Harry Blackmore Award (2004) the Australian Lions Foundation William R. Tresise Fellow Award for humanitarian services (2002) and the Fiona Stanley Medal (2001).
He studied medicine at the University of Queensland and trained in Australia as well as in the United States of America where he worked at the Mayo clinic in Rochester, Minnesota. Currently, Dr Coates works at Princess Margaret Hospital as well as several other hospitals in Perth. He undertakes an active role in the management of Aboriginal ear health. He is the author of numerous book chapters and over 66 papers. He is a member of 15 learned societies and committees both in medicine and the arts. Dr Coates is married with two children and two grandchildren.
Ms Kathy Currie
Kathy Currie is an audiologist who has lived and worked in the Northern Territory (NT) for the last 16 years. During this time she worked in Indigenous ear and hearing health programs and provided clinical, advocacy, policy, strategy and project management services. Throughout her work in Indigenous ear and hearing health, Kathy has been employed in Australian Government, the Aboriginal community controlled sector and the NT Government. As part of the follow up ear, nose and throat (ENT) and hearing projects for the Northern Territory emergency response (NTER) child health check initiative, Kathy developed strategic initiatives and care models. Kathy is currently the Hearing Health Program Leader at the Hearing Health Strategic Unit, Department of Health, NT.
Dr Damien Howard
Dr Damien Howard is a Darwin based psychologist and educator who has specialised in identifying and addressing the impact of widespread Indigenous hearing loss. He has conducted research and created resources on this issue in the education, health, employment and criminal justice sectors. His work is available at www.eartroubles.com as well as on the Australian Indigenous HealthInfoNet website.
Mr Paul Huntley
Paul Huntley is a Senior Policy Officer with the Centre for Aboriginal Health, in the New South Wales (NSW) Health Department, Sydney. He is responsible for the evaluation, monitoring and reporting arrangements in relation to grant administration for the Aboriginal non-government organisation (NGO) sector. Paul also has portfolio responsibility for the NSW Aboriginal ear health program. Prior to working with NSW Health, Paul worked with the Office for Aboriginal and Torres Strait Islander Health until late 2001.
Ms Sandra Nelson
Sandra Nelson is a Senior Registered Aboriginal Health Worker with audiometry training. She has specialised in the field of ear and hearing health and has run an ear and hearing health clinic in a community controlled Aboriginal medical service (AMS). She is on a number of committees for research into ear and hearing health. Sandra is also the Chairperson on an Indigenous reference group for the PneuMum clinical trial through Menzies School of Health Research. At present, she works for Northern Territory (NT) Hearing, and is the Remote Community Audiometrist for East Arnhem Land. Sandra provides training and education to all health staff including schools and child care centres.
Professor Neil Thomson
Professor Neil Thomson is Director of the Australian Indigenous HealthInfoNet.
Dr Andrew White
During registrar secondments to Alice Springs Hospital in the mid 1990s, Andrew developed an interest in Indigenous child health. He worked at Menzies School of Health Research in Darwin from 1998-2000 on several research projects related to child antecedents of adult renal disease. He then worked as community paediatrician in Alice Springs from 2000-2008 providing clinical paediatric services to children and families in remote Central Australia, and working on public health and primary care child health projects.
He is currently the Director of Paediatrics at Townsville Hospital and Senior Lecturer at James Cook University School of Medicine. He contributes to paediatric outreach to Palm Island Indigenous community and is an editor of the Central Australian Rural Practioners Association (CARPA) standard treatment manual.
His interests include providing general paediatric, and child health services to children in remote communities, epidemiology and prevention of ill health, and improving primary health care for remote children. He is also interested in the training of doctors at undergraduate and postgraduate level.
Media personality, Mr Ray Martin, launched the Indigenous EarInfoNet at Menzies School of Health Research in Darwin on 16 March 2007. A Family Fun Day was held at Menzies which included kids entertainment, Captain Starlight (from the Starlight Foundation), traditional dancing, BBQ, Indigenous child health info, music, dancing and much much more!
Otitis media terms:
Otitis media: Refers to all forms of inflammation and infection of the middle ear. Active inflammation or infection is nearly always associated with a middle ear effusion (fluid in the middle ear space).
Otitis media with effusion (OME): Presence of fluid behind the eardrum without any acute symptoms. Other terms have also been used to describe OME (including ‘glue ear', ‘serous otitis media', and ‘secretory otitis media'). OME may be episodic or persistent. A type B tympanogram or reduced mobility of the eardrum on pneumatic otoscopy are the most reliable indicators of OME.
Persistent (Chronic) otitis media with effusion: Presence of fluid in the middle ear for more than 3 months without any symptoms or signs of inflammation.
Acute otitis media (AOM): General term for both acute otitis media without perforation and acute otitis media with perforation. It is defined as the presence of fluid behind the eardrum plus at least one of the following: bulging eardrum, red eardrum, recent discharge of pus, fever, ear pain or irritability. A bulging eardrum, recent discharge of pus, and ear pain are the most reliable indicators of AOM.
Acute otitis media without perforation (AOMwoP): The presence of fluid behind the eardrum plus at least one of the following: bulging eardrum, red eardrum, fever, ear pain or irritability. A bulging eardrum and /or ear pain are the most reliable indicators of AOMwoP.
Acute otitis media with perforation (AOMwiP): Discharge of pus through a perforation (hole) in the eardrum within the last 6 weeks. The perforation is usually very small (a pinhole) when the eardrum first ruptures. The perforation can heal and re-perforate after the initial onset of AOMwiP.
Recurrent acute otitis media (rAOM): The occurrence of 3 or more episodes of acute otitis media (AOM) in a 6 month period, or occurrence of 4 or more episodes in the last 12 months.
Chronic suppurative otitis media (CSOM): Persistent discharge of pus through a persistent perforation (hole) in the eardrum for at least 6 weeks.
Dry perforation: Presence of a perforation (hole) in the eardrum without any signs of discharge or fluid behind the eardrum. Some people also refer to this as inactive CSOM.
Otitis externa: Infection of the ear canal associated with pain, swelling and discharge. Other terms have also been used to describe otitis externa (including ‘tropical ear and ‘swimmers' ear'). This is not a form of otitis media.
Population at high-risk of persistent (chronic) OME: In this document, children living with recognised OM risk factors are considered to be a high risk population for persistent OME. The most important risk factors are strong family history for OM, attending child care, frequent exposure to other children, and being of Aboriginal and/or Torres Strait Islander descent.
Population at high-risk of CSOM: In this document, populations with a prevalence rate of chronic suppurative otitis media of greater than 4% are described as high-risk for CSOM. This will apply to most rural and remote Aboriginal communities where persistent disease and chronic perforation of the eardrum are common. The World Health Organization has recommended that rates higher than 4% are unacceptable and represent a massive public health problem.
Surveillance for otitis media: The systematic and ongoing collection, analysis, and interpretation of measures of middle ear disease and hearing loss in order to identify and correct deviations from normal.
Screening for otitis media: Any measurement aimed at identifying individuals who could potentially benefit from an intervention for otitis media. This may include the use of symptoms, signs, laboratory tests, or risk scores for the detection of existing or future middle ear disease.
Otoscopy: Looking in the ear with a bright light to identify features associated with outer or middle ear disease. This is sometimes referred to as "simple otoscopy".
Pneumatic otoscopy: The combination of simple otoscopy with the observation of eardrum movement when air is blown into the ear canal. Pneumatic otoscopy is able to determine mobility of the eardrum. Reduced mobility of an intact eardrum is a good indication of the presence of middle ear fluid.
Video-otoscopy: Observing the eardrum via a small camera placed in the ear canal which displays the image on a screen. Video pneumatic otoscopy is also possible.
Tympanometry: An electro-acoustic measurement of the stiffness, mass and resistance of the middle ear (more simply described as mobility of the eardrum). This test can be used to describe normal or abnormal middle ear function.
Acoustic reflectometry: A simple, painless and non invasive diagnostic tool for detecting middle ear effusion. It performs spectral gradient analysis of sound reflected off the eardrum. This is often a less sensitive and specific test than pneumatic otoscopy or tympanometry. It has the advantage that it is very easy to perform with uncooperative children.
Grommet: A small tube surgically placed across the eardrum to re-establish ventilation to the middle ear. It is also called a ventilation tube, a PE tube (pressure equalisation tube), or a tympanostomy tube.
Insufflation: Blowing air into the ear to determine the mobility of the eardrum. This is done as part of pneumatic otoscopy.
Mastoiditis: Infection of the mastoid air cells in the mastoid bone (behind the middle ear).
Attic perforation: This is a perforation in the superior part of the eardrum. A perforation in this location may be associated with a deep retraction pocket or cholesteatoma.
Myringotomy: A surgical incision in the eardrum to drain fluid.
Myringoplasty: A surgical operation to repair a damaged eardrum.
Tympanocentesis: The insertion of a needle through the tympanic membrane in order to aspirate fluid from the middle ear space.
Tympanoplasty: A surgical operation to correct damage to the middle ear and restore the integrity of the eardrum, and bones of the middle ear.
Adenoidectomy: A surgical operation to remove the adenoid tissue in the back of the nose (near the tonsils).
Mastoidectomy: A surgical operation to remove infected mastoid air cells in the mastoid bone.
Audiological terms:
Conductive hearing loss (CHL): Hearing loss that results from dysfunction of the outer or middle ear that interferes with the efficient transfer of sound to the inner ear. It is characterized by a loss in sound intensity.
Sensorineural hearing loss (SL): Hearing loss that results from dysfunction in the inner ear (especially the cochlea) where sound vibrations are converted into neural signals. This type of hearing loss may also occur secondary to dysfunction of any part of the auditory nerve.
Screening for hearing loss: Any measurement aimed at identifying individuals who could potentially benefit from an intervention for hearing loss. This may include the use of risk factors, symptoms, signs, electro-acoustic tests or behavioural tests for the detection of existing or future hearing loss.
Universal neonatal hearing screening: The use of objective audiometric tests to identify neonates who might have significant congenital hearing loss.
Audiometry (hearing assessment): The testing of a person's ability to hear various acoustic stimuli.
Pure-tone audiometry: The assessment of hearing sensitivity for pure-tone stimuli in each ear. This is done using headphones (air conduction) or via bone conductors (bone conduction). Testing is possible from around three years of age.
Visual reinforcement audiometry: A technique that enables assessment of hearing sensitivity in young children from around six months to three years of age. This testing does not allow the testing of each ear individually.
Hearing loss: Any hearing threshold response outside the normal range that is detected by audiometry. It can be at any test frequency in either ear.
Hearing loss in a population: The number of children who have abnormal hearing. Hearing loss may affect one ear (unilateral) or affect both ears (bilateral).
Fluctuating hearing loss: Hearing loss that changes significantly over time resulting in inconsistent auditory input. Conductive hearing loss is often associated with fluctuations related to changes in the otitis media condition.
Hearing impairment classification: A categorisation that describes the degree of disability associated with hearing loss in the better ear. Hearing impairment classification applies a graded scale of mild, moderate, severe and profound. This is based on degree of deviation from normal thresholds in the "better ear" as recorded through audiometry. It is typically calculated as a 3 frequency average (3FA) of the threshold of hearing (in dBHL) at 500Hz, 1000Hz and 2000Hz. However, hearing loss associated with otitis media can vary in severity over time and have a substantial effect upon hearing for frequencies outside those routinely tested. In addition, this classification is based on pure tone audiometry on the test day and does not account for language, processing, environmental and early onset factors. Hence, average hearing levels based upon a single assessment of the standard three test frequencies could underestimate the degree of impairment.
Helping to 'close the gap' by providing the evidence base to inform practice and policy in Aboriginal and Torres Strait Islander health
