Otitis media guidelines for Australian Aboriginal and Torres Strait Islander children: summary of recommendations

Abstract

Introduction The 2001 Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Islander populations were revised in 2010. This 2020 update by the Centre of Research Excellence in Ear and Hearing Health of Aboriginal and Torres Strait Islander Children used for the first time the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Main recommendations We performed systematic reviews of evidence across prevention, diagnosis, prognosis and management. We report ten algorithms to guide diagnosis and clinical management of all forms of otitis media. The guidelines include 14 prevention and 37 treatment strategies addressing 191 questions. Changes in management as a result of the guidelines A GRADE approach is used. Targeted recommendations for both high and low risk children. New tympanostomy tube otorrhoea section. New Priority 5 for health services: annual and catch‐up ear health checks for at‐risk children. Antibiotics are strongly recommended for persistent otitis media with effusion in high risk children. Azithromycin is strongly recommended for acute otitis media where adherence is difficult or there is no access to refrigeration. Concurrent audiology and surgical referrals are recommended where delays are likely. Surgical referral is recommended for chronic suppurative otitis media at the time of diagnosis. The use of autoinflation devices is recommended for some children with persistent otitis media with effusion. Definitions for mild (21–30 dB) and moderate (> 30 dB) hearing impairment have been updated. New “OMapp” enables free fast access to the guidelines, plus images, animations, and multiple Aboriginal and Torres Strait Islander language audio translations to aid communication with families.

High prevalence of hearing loss in urban Aboriginal infants: the Djaalinj Waakinj cohort study

“…The mean hearing response in infants with abnormal tympanograms was 40.7 dB, a level at which they would not hear normal voices clearly, with implications for later speech, language, and behavioural development 8 . Our findings support early monitoring of otitis media and hearing loss in Indigenous children, with prompt referral for audiological assessment as recommended by Australian otitis media guidelines 1 …”

“…Otitis media and associated hearing loss are highly prevalent in Indigenous Australian children 1 . Most relevant prevalence studies have been undertaken in rural and remote regions, although most Indigenous children live in urban areas 2 .…”

: placing resistance to third-generation cephalosporins and fluoroquinolones in Australia and New Zealand into perspective

“…These communities are at a higher risk of infections for which quinolones are indicated. For example, non-ototoxic ciprofloxacin ear drops are the mainstays of treatment for chronic suppurative otitis media, which affects 9 in 10 Aboriginal and Torres Strait Islander peoples younger than 3 years of age in remote Northern Territory (Australia) communities 12 .…”

Ear microbiota and middle ear disease: a longitudinal pilot study of Aboriginal children in a remote south Australian setting

“…It is notable that the bacterial species detected in our analysis, including those present in the ear canal in children with perforated tympanic membranes, sit within the spectrum of activity of standard antibiotic therapies for OM [ 15 ]. Where OM is recurrent, the surgical insertion of a grommet into the tympanic membrane can be used to prevent the build-up of fluid in the middle ear (a measure that was performed in just over a quarter of the study participants during the period of investigation).…”

“…The profound impact of OM on the long-term health and well-being of Australian Aboriginal children demands the development of more effective prevention and treatment strategies. Specific prevention, diagnosis, and treatment guidelines for OM in Australian Aboriginal and Torres Strait Islander children have been developed in recognition of the unique burden of disease and healthcare provision challenges in remote sites [ 15 ]. Of particular consideration is the microbiology of OM.…”