Ear health

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Ear health and hearing

There are three main parts of the ear (external, middle and inner ear) and diseases of the ear are classified according to the part where the disorder occurs [1]. Inflammation and infection of the middle ear, which are nearly always associated with fluid in the middle ear space, are referred to as otitis media (OM) [2].

OM can be caused by viruses or bacteria or both, and often occurs as a result of another illness such as a cold [1]. It can cause intermittent or persistent hearing impairment; the risk of permanent hearing loss increases if OM becomes chronic and is not adequately treated and followed up. Persistent ear discharge through a perforation (hole) in the eardrum is referred to as chronic suppurative otitis media (CSOM) [2]. For a diagnosis of CSOM, the tympanic membrane perforation must be able to be seen and large enough to allow the discharge to flow out of the middle ear space.

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 [1][3][4].

OM, particularly in suppurative forms, is associated with impairment of hearing, with major implications for language development and learning [5][4][6]. OM can affect Indigenous babies within weeks of birth and a high proportion of children living in remote communities will continue to suffer from CSOM throughout their developmental years [6].

Extent of ear disease among Indigenous people

Prevalence

Exceptionally high levels of ear disease and hearing loss have been reported for many years in many Indigenous communities, particularly in remote areas [4][7][8][9]. 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’ ([10], 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 [9].

Australia-wide, ear/hearing problems were reported by 12% of Indigenous people who participated in the 2004-2005 NATSIHS [11]. These problems were reported slightly more frequently by Indigenous people living in remote areas (13%) than by those living in non-remote areas (12%), but the difference is not statistically significant. Complete or partial deafness was reported by 9% of Indigenous people living in both remote and non-remote areas. The level of OM was higher for Indigenous people living in remote areas (4%) than for those living in non-remote areas (2%).

After age-adjustment, OM was 2.8 times more common for Indigenous people than for non-Indigenous people [11]. The prevalence of ear/hearing problems, including total/partial hearing loss and OM, was over three times higher among Indigenous children aged 0-14 years (10%) than among their non-Indigenous counterparts. The levels of complete/partial deafness were higher for Indigenous people than for non-Indigenous people for all age-groups except people aged 55 years or older (who had similar levels).

The NT Emergency Response (NTER) child health checks conducted in the period from July 2007 to June 2012 found that 67% of the 5,474 children who received an ear, nose, throat (ENT) consultations or audiology service had at least one middle ear condition [12]. More than one-half (51%) of the 5,184 children aged under 16 years who received an audiology check had hearing loss in at least one ear.

The 2008 NATSISS, which collected information on total/partial deafness, OM, ringing in ears (tinnitus), and otitis externa (infection of the ear canal), found that 10% of Indigenous children aged 4-14 years experienced an ear or hearing problem [5].

Information collected by the WAACHS in 2001-2002 revealed that 18% of Indigenous children aged 0-17 years were reported by carers as having had recurring ear infections [13]. Children aged 0-3 years (20%) and 4-11 years (20%) were more likely to have recurring ear infections than were children aged 12-17 years (14%). Abnormal hearing was reported for 6.8% of the children aged 4-17 years. Of children aged 4-11 years who experienced recurring ear infections with discharge, 28% had abnormal hearing, compared with 1.4% of those without ear infections.

General practice attendances and hospitalisation

According to the Bettering the Evaluation of Care and Health (BEACH) survey data, the rates of GP attendances for the period from April 2006 to March 2011 for Indigenous children aged 0-14 years were 1.1 times the non-Indigenous rate for OM/myringitis (inflammation of the tympanic membrane) and 1.2 times the non-Indigenous rate for total diseases of the ear [14].

The hospitalisation rate for diseases of the ear and mastoid process for Indigenous people in 2010-11 was 1.3 times the non-Indigenous rate [15]. For the period from July 2008 to June 2010, the hospitalisation rate for Indigenous people for all ear disease combined was around 1.3 times higher than the non-Indigenous rate [14]. The rate for Indigenous children aged 5-14 years was twice as high as that for non-Indigenous children, but the rate for Indigenous children aged 0-4 years were less than for their non-Indigenous counterparts. The hospitalisation rate for tympanoplasty procedures (a reconstructive surgical treatment for a perforated eardrum) for Indigenous children aged 0-14 years was 7.3 times the rate of other children. In 2009-10, the rate for myringotomy procedures (incision in the eardrum to relieve pressure caused by excessive fluid build-up) was lower for Indigenous people (1.4 per 1,000) than for non-Indigenous people (1.7 per 1,000).

As with many other areas of Indigenous health, high rates of recurring ear infections are associated with poverty, crowded housing conditions, inadequate access to clean water and functional sewerage systems, nutritional problems, and poor access to health care [16]. Importantly, ear infections can lead to hearing loss, which may be a major contributor to poor education and to unemployment, which are risk factors for contact with the justice system [4].

References

1. 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
2. Darwin Otitis Guidelines Group (2010) Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations. Darwin: Menzies School of Health Research
3. Access Economics (2008) The cost burden of otitis media in Australia. Canberra: Access Economics
4. Couzos S, Metcalf S, Murray R (2008) Ear health. In: Couzos S, Murray R, eds. Aboriginal primary health care: an evidence-based approach. 3rd ed. South Melbourne: Oxford University Press: 308-354
5. Australian Bureau of Statistics (2009) National Aboriginal and Torres Strait Islander social survey, 2008. Retrieved 11 April 2011 from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4714.0?OpenDocument
6. Burrow S, Galloway A, Weissofner N (2009) Review of educational and other approaches to hearing loss among Indigenous people. Retrieved from http://www.healthinfonet.ecu.edu.au/other-health-conditions/ear/reviews/our-review-education
7. Senate Community Affairs References Committee (2010) Hear us: inquiry into hearing health in Australia. Canberra: Parliament of Australia: Senate
8. Gunasekera H, Morris PS, Daniels J, Couzos S, Craig JC (2009) Otitis media in Aboriginal children: the discordance between burden of illness and access to services in rural/remote and urban Australia. Journal of Paediatrics and Child Health; 45(7-8): 425–430
9. Morris PS, Leach AJ, Silberberg P, Mellon G, Wilson C, Hamilton E, Beissbarth J (2005) Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross-sectional survey. BMC Pediatrics; 5: 27 Retrieved 5 April 2012 from http://dx.doi.org/10.1186/1471-2431-5-27
10. WHO/CIBA (2000) Prevention of hearing impairment from chronic otitis media. Geneva: WHO
11. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics
12. Australian Institute of Health and Welfare (2012) Northern Territory emergency response child health check initiative - follow-up services for oral and ear health: final report 2007-2012. Canberra: Australian Institute of Health and Welfare
13. Zubrick SR, Lawrence DM, Silburn SR, Blair E, Milroy H, Wilkes T, Eades S, D'Antoine H, Read AW, Ishiguchi P, Doyle S (2004) The health of Aboriginal children and young people. Perth: Telethon Institute for Child Health Research
14. Australian Health Ministers’ Advisory Council (2012) Aboriginal and Torres Strait Islander health performance framework: 2012 report. Canberra: Office for Aboriginal and Torres Strait Islander Health, Department of Health and Ageing
15. Australian Institute of Health and Welfare (2012) Australian hospital statistics 2010-11 supplementary tables. Canberra: Australian Institute of Health and Welfare
16. Steering Committee for the Review of Government Service Provision (2011) Overcoming Indigenous disadvantage: key indicators 2011. Canberra: Productivity Commission, Australia