Surgery for otitis media among Indigenous Australians

Abstract

Otitis media with effusion and recurrent acute otitis media are ubiquitous among Indigenous children. Otitis media causes conductive hearing loss that may persist throughout early childhood and adversely affect social interactions, language acquisition and learning. Control of otitis media usually restores hearing to adequate levels. Surgery is to be considered when otitis media has not responded to medical treatment. In non‐Indigenous populations, tympanostomy tubes (“grommets”), with or without adenoidectomy, can control otitis media; how these findings relate to Indigenous Australians is not known. Tympanic membrane perforation is a frequent sequela of early childhood otitis media among Indigenous children. It occurs as early as 12 months of age and causes conductive hearing loss. Perforation is associated with recurrent aural discharge, particularly in the tropics and in desert regions. Medical and public health management is required until a child is old enough to undergo surgical closure of the perforation, usually by an age of 7–10 years. Surgical closure of the tympanic membrane stops the aural discharge and improves the hearing sufficiently to avoid the need for hearing aids in most cases. The success rate of surgery conducted in rural and remote Australia is below urban benchmarks; improving this will probably require funding for community‐based follow‐up.

Longitudinal analysis of ear infection and hearing impairment: findings from 6-year prospective cohorts of Australian children

“…As well, we confirm that the onset of ear infection is associated with an increased likelihood of repeated episodes and these children are at a much higher risk of long-term negative impact [35]. Our findings provide clear evidence that ear infection leads to hearing impairment and the consequences of ear infections may persist throughout early childhood, potentially compromising children’s language acquisition, learning ability, and social interactions [36]. …”

Otitis media among high-risk populations: can probiotics inhibit Streptococcus pneumoniae colonisation and the risk of disease?

“…Indigenous children usually develop OM early in life [21], they experience frequent and severe episodes and are more likely to develop complications compared to non-Indigenous children [11,31,[52][53][54][55][56]. Indigenous children may be more vulnerable to social disadvantage that may accompany longstanding hearing impairment [7,57]. This dichotomy between Indigenous and non-Indigenous children in terms of incidence, pathogenesis, severity, complications and long-term outcomes of OM needs to be addressed in order to arrive at an effective management strategy for OM in high-risk populations [31].…”

“…Treatment with antibiotics can disrupt the balance of the nasopharyngeal microflora, further facilitating colonisation with pathogens [68]. Both the long-term use of oral antibiotics [69] and pneumococcal vaccination [70] have been shown to decrease the prevalence of tympanic membrane perforation in young indigenous children, but did not affect the prevalence of OM significantly [57]. Maternal pneumococcal vaccination trials are currently underway as possible strategies against middle ear infection and pneumococcal carriage among high-risk populations [71].…”

Permeatal ‘push through’ myringoplasty in the Northern Territory: a prospective cohort

“…Previous studies assessing the efficacy of myringoplasty in the Indigenous populations, using a range of techniques and graft materials, have reported mixed outcomes with neo-tympanum integrity ranging from 30-60.1% (4)(5)(6)(7)(8)(9). This differs from the results in non-Indigenous patients where a closure rate of 90% can be expected (2). The follow-up rates in these studies have generally been low (from 25-78%), attributable to the remoteness of the communities and to the challenge of accessibility to healthcare due to language and cultural barriers (2,4,5).…”

“…The heavy burden of ear disease due to perforations in the Indigenous population is well established. Indigenous children suffer from higher rates of tympanic perforation than their non-Indigenous counterparts with prevalence as high as 60% at 2 years of age and continuing above 10% over the age of 16 (1)(2)(3). Previous studies assessing the efficacy of myringoplasty in the Indigenous populations, using a range of techniques and graft materials, have reported mixed outcomes with neo-tympanum integrity ranging from 30-60.1% (4)(5)(6)(7)(8)(9).…”