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spacing1What is known about ear health and hearing?

ear banner

These FAQs aim to provide information about ear health and hearing with links to further information.

Diagnosis

What is otitis media (OM)?

The main types of OM are:

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

What are the main bacterial causes of ear disease?

Three bacterial pathogens appear the be the main cause of otitis media:

Streptococcus pneumonia also refered to as pneumococcus is associated with the majority of otitis media cases particularly severe cases.

View information: Review of health and hearing among Indigenous peoples

What resources can I use to improve my diagnostic skills?

I have a limited budget, what ear examination equipment should I buy?

Determine what are the most common ear conditions in your population. If there is a high prevalence of eardrum perforations, you might need equipment to clean the canal, e.g. headlight, suction, ear canal instruments.

LumiView (Welch Allyn) or Voroscope (Vorotek): instruments which illuminate the ear canal and leave both hands free to use instruments. Models are either eyeglass-mounted (for individuals who need corrective lenses) or headband-mounted for general use in a clinic. Other uses include for suturing, taking Pap smear tests, etc.

If there is a high prevalence of OME (intact eardrums), pneumatic otoscopy and tympanometry are useful (tympanometry is not performed on ears with obvious pus or drum perforation)

Both techniques:

A pneumatic bulb is an inexpensive addition to the standard otoscope. The user needs training but it's quick to learn if they have basic otoscopy skills. Tympanometry is more expensive, needs a power source, the user needs training, it's harder to interpret and easier to make mistakes.

Source: Australian Medicare Local Alliance

Is there a manual for Aboriginal Health Workers on ear disease?

The Aboriginal ear health manual (2008) provides information on the anatomy and function of the ear and preventive measures for ear problems. It details causes, types and effects of hearing loss together with common ear conditions. Diagrams and images are used to describe how to examine ears and algorithms for treatment strategies are provided.

View information: The Aboriginal ear health manual

Medical

What is covered in the Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010?

The updated Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010 is designed to facilitate the delivery of comprehensive, effective and appropriate ear health programs. The guidelines provide practical treatment plans.

The guidelines are made up of 10 components:

  1. A table of practical treatment plans which summarise the management of childhood otitis media in populations at high risk of CSOM.
    sections on:
  2. Prevention of otitis media and hearing loss
  3. Diagnosis of otitis media
  4. Prognosis following OM
  5. Medical management for each of the OM presentations
  6. Audiological assessment and management of any associated hearing loss. This is a new section that was not in the 2001 guidelines.
  7. Practical considerations relevant to health care delivery for populations affected by OM.
  8. Prioritisation of services where resources are limited. This is also a new section that was not in the 2001 guidelines.
  9. A set of clinical care algorithms for each OM presentation
  10. A list of key messages for primary health care providers working with populations affected by OM.

The aim of all these components is to offer a series of clear recommendations that are:

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

Who are the intended users of the Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010?

The intended users of the guidelines are health professionals who work with Aboriginal and Torres Strait Islander populations. This includes Aboriginal Health workers, Aboriginal ear health workers, primary care and specialist physicians, nurses, remote area nurses and nurse practioners, audiologists, audiometrists, speech therapists, and child development specialists.

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

Why do the Guidelines recommend Ciprofloxacin drops for CSOM instead of Sofradex?

The guidelines recommend Ciprofloxacin for CSOM instead of Sofradex as there is a very small risk of ototoxicity (damage to the cochlea) from the active ingredients of Sofradex - refer to comparative trials referenced in the Guidelines.

Source: Australian Medicare Local Alliance

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

Can I still use Sofradex?

Sofradex should only be used for infections in the external canal, i.e. otitis externa/Swimmer's ear/Tropical ear (when the eardrum is intact), but not for CSOM.

Source: Australian Medicare Local Alliance

When can/should I syringe the ears?

Ears can be syringed if there is profuse mucopus present in the canal or a foreign body such as an insect. Also, syringe to remove profuse soft wax or after using eardrops to soften impacted wax (if the eardrum is known to be intact).

Source: Australian Medicare Local Alliance

How else can I clean discharge, wax or foreign bodies from the ears?

Impacted wax may need to be softened with eardrops, e.g. Cerumol, Waxsol, or a solution of bicarbonate of soda. Dry or soft wax and some foreign bodies can be removed with alligator forceps or a wax loop using a head-light or other illuminating/magnifying instrument. Tissue/toilet paper spears are the method of choice for families to remove pus discharge before putting in eardrops. If available in the clinic, suction can be used. Cotton buds are not effective for removing wax or discharge - they are too fat and not sufficiently absorbent.

Source: Australian Medicare Local Alliance

How do I make tissue spears?

The Tissue spears: do it right DVD resource shows health personnel and families how to clean pus out of the ear using tissue spears. Diagrams, images and short videos are used to demonstrate. This resource should ideally be used by health professionals with clients and families so that they can help them understand some of the more complex ideas portrayed.

Source: Menzies School of Health Research

View information: The tissue spears: do it right DVD

Are there any resources available to give to families about ear disease?

The resources recommended for parents and carers are:

The resource materials are available to download from the Care for kids' ears website and hard copies of the resource materials can be requested using an online order form.

View information: Care for kids

Audiological

What is conductive hearing loss?

Conductive hearing loss results from dysfunction of the outer or middle ear that interferes with the efficient transfer of sound to the inner ear. It is characterised by a loss in sound intensity.

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

What is sensorineural hearing loss?

Sensorineural hearing loss results from dysfunction in the inner ear (especially the cochlea). This is 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.

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

Hearing tests are recommended for many ear conditions - how often should they be performed for patients with chronic problems?

If a referred patient is found to have a significant hearing loss requiring hearing rehabilitation services, the audiology service (typically Australian Hearing) will manage the hearing review schedule to meet the individual's rehabilitation goals.

A patient with chronic ear disease who has adequate hearing on the first hearing test should still be considered at-risk for hearing loss and be referred again in 6 months if the ear condition has not improved. A patient should also have a review hearing assessment if there is a change in his/her ear state.

A patient should be referred for hearing assessment if the patient, family or teacher observes deteriorating responsiveness to sound.

Source: Australian Medicare Local Alliance

I cannot access audiology assessment readily - what can I do locally?

Basic hearing tests can be performed on children from the age of about five years in primary health clinics if there is suitable equipment, a quiet environment and a trained tester available. (See COMHeLP - the Audiology Australia Guidelines for more information).

Also, advise families and teachers to use clear communication (see Section E. Audiological), e.g. speak clearly and slightly more slowly, pause and wait for a response.

Source: Australian Medicare Local Alliance

I cannot access speech pathology services readily - what can I do locally?

Encourage families to stimulate verbal communication: talk to babies and children about what they are doing and what you are doing. Talk a lot - speak to them close up and in a clear voice. Tell stories, draw pictures, read books (with or without printed words). Accept and encourage all attempts at talking. Use other services, e.g. HIPPY, if available in your local area.

Source: Australian Medicare Local Alliance

What services does Australian Hearing offer?

Australian Hearing services include provision of hearing services to Aboriginal and Torres Strait Islander children and eligible adults. It produces a range of information fact-sheets and brochures on specific topics for Aboriginal and Torres Strait Islander communities including otitis media and sound-field systems in the classroom. The website also provides general information brochures on topics such as hearing loss, hearing aids and noise exposure.

Source: Australian Hearing

View information: Australian Hearing

What is tympanometry?

An electro-ascoutic 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.

Source: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

What is 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.

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

What can I use to help explain hearing loss to my families?

Ear troubles is a book has been designed to help health workers and others talk to parents about conductive hearing loss.

View information: Ear troubles

How can I get hearing help for an adult patient?

Hearing rehabilitation starts with an assessment of hearing and hearing needs, so find out who in your area does this. See Further Learning, Resources for a list of State/Territory and National hearing services. See Commonwealth Hearing Services Program and Hearing Aid Bank.

Source: Australian Medicare Local Alliance

Surgical

What is a myringotomy?

Myringotomy is a surgical incision in the eardrum to drain fluid.

Source: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

What is a myringoplasty?

Myringoplasty is a surgical operation to repair a damage eardrum.

Source: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

What is a tympanoplasty?

Tympanoplasty is a surgical operation to correct damage to the middle ear and restore the integrity of the eardrum and bones of the middle ear.

Source: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

What are grommets?

Grommets are also known as 'typanostomy tubes', 'ventilation tubes' or a 'PE tubes', they are small tubes surgically placed across the eardrum to re-establish ventilation to the middle ear.

Source: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

Priorities

What are the key messages for Primary Health Care Providers?

  1. Tell families that Aboriginal children are at risk of otitis media.
  2. Inform families that improved living standards, maternal education, breast feeding, a smoke-free environment and pneumococcal vaccination will lead to improvements in OM.
  3. Encourage families to attend the health clinic as soon as possible when they develop ear pain or discharge.
  4. It is recommended that children have their ears examined regularly even when well.
  5. It is recommended that all Aboriginal children with Acute Otitis Media be treated with antibiotics (amoxicillin) until the bulging and discharge has resolved.

Source: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

What are the best treatment options for otitis media?

The updated Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010 is designed to facilitate the delivery of comprehensive, effective and appropriate ear health programs. The guidelines provide practical treatment plans.

Source: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

View information: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations 2010

What are the key messages for Primary Health Care Providers?

How can I connect to other people working in ear health?

The EarInfoNetwork yarning place enables people to share information, knowledge and experience with other people working in ear health around Australia.

Source: EarInfoNet

View information: yarning places

© Australian Indigenous HealthInfoNet 2013 
This product, excluding the Australian Indigenous HealthInfoNet logo, artwork, and any material owned by a third party or protected by a trademark, has been released under a Creative Commons BY-NC-ND 3.0 (CC BY-NC-ND 3.0) licence. Excluded material owned by third parties may include, for example, design and layout, images obtained under licence from third parties and signatures.

 

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    Last updated: 29 May 2012
     
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