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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 and 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 tympanic membrane (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][7]. 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][8][9][10]. 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’ ([11], 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 [10].

Diseases of the ear and mastoid and/or hearing problems were reported as a long-term health condition by 12% of Indigenous people who participated in the 2012-2013 AATSIHS [12]. Ear/hearing problems were reported by the same proportion of Indigenous people in non-remote areas and remote areas (both 12%). Ear/hearing problems were reported by 13% of Indigenous males and by 12% of Indigenous females. After age-adjustment, there were statistically significant differences between rate ratios for Indigenous people and non-Indigenous people for ear and mastoid and/or hearing problems (rate ratio 1.3: rate ratio of 1.2 for males and a rate ratio 1.5 for females), and in all age-groups under 55 years.

The proportion of Indigenous people with ear/hearing problems increased with age, ranging from 7% of Indigenous children aged 0-14 years, to 28% of those aged 55 years and over [12]. The same proportions of Indigenous children aged 0-14 years were reported to have hearing loss (3%) and OM (3%). Hearing loss was the most commonly reported ear/hearing problem in all other age-groups, affecting between 7% of Indigenous people aged 15-24 years and 26% of those aged 55 years and over.

Hearing health services delivered under the National partnership agreement on stronger futures in the Northern Territory in 2012-13 provided audiology services to 1,541 Indigenous children: 72% of children who received audiology services were diagnosed with at least one type of middle ear condition [13]. The most common condition among the Indigenous children was otitis media with effusion (OME) (25%) followed by Eustachian tube dysfunction (17%), CSOM (13%), dry perforation (12%), and acute OM (AOM) (8%). Of the children who received audiology services 51% had some form of hearing loss: 36% had bilateral hearing loss; 15% had loss in one ear; and around 10% had moderate, severe or profound hearing impairment.

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 ear, nose and throat (ENT) consultations or audiology services had at least one middle ear condition [14]. 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 [15]. 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 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 [16].

There were 2,584 hospital separations for diseases of the ear and mastoid process (portion of the temporal bone of the skull behind the ear) among Indigenous people in 2011-12, representing 0.7% of separations identified as Indigenous (excluding dialysis) [17]. The hospitalisation rate was 1.3 times the non-Indigenous rate. 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 [16]. 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 was lower 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 [18]. 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. O'Neill G (2012) Otitis media: silent epidemic. Australian Life Scientist; 9(3): 42-44
  8. Senate Community Affairs References Committee (2010) Hear us: inquiry into hearing health in Australia. Canberra: Parliament of Australia: Senate
  9. 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
  10. 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
  11. WHO/CIBA (2000) Prevention of hearing impairment from chronic otitis media. Geneva: WHO
  12. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13. Canberra: Australian Bureau of Statistics
  13. Australian Institute of Health and Welfare (2014) Stronger futures in the Northern Territory: hearing health services 2012 - 2013. Canberra: Australian Institute of Health and Welfare
  14. 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
  15. 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 [volumes 1-4]. Perth: Telethon Institute for Child Health Research
  16. 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
  17. Australian Institute of Health and Welfare (2013) Australian hospital statistics 2011–12. Canberra: Australian Institute of Health and Welfare
  18. Steering Committee for the Review of Government Service Provision (2011) Overcoming Indigenous disadvantage: key indicators 2011. Canberra: Productivity Commission, Australia
 
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