Otitis media (OM) is one of the most common reasons why young children present to medical practitioners and winter is peak season. Approximately 75% of children have at least one episode of otitis media by school age. Those between 6-18 months of age are at a higher risk. The incidence of OM decreases after the age of six.
Acute otitis media causes pain, fever, and occasionally perforation. The child will be irritable, and sleep may be disrupted. Treatment is usually symptomatic control with adequate pain relief and antibiotics orally may be required. Symptoms may take one to two weeks to resolve. Recurring middle ear infections of three episodes or more in six months may warrant further assessment.
Otitis media with effusion or ‘glue ear’ is accumulation of fluid in the middle ear. These children may have hearing loss, speech delay, learning difficulties and imbalance.
Common predisposing factors are day-care attendance, frequent upper respiratory tract infections; exposure to cigarette smoke; bottle feeding; and use of pacifiers.
Children with excessive middle ear infections not responding to conservative measures will need review by a paediatric ENT surgeon. An audiological assessment will be part of the examination. Surgery (usually grommet insertion and/or adenoidectomy) may be recommended.
Djaalinj Waakinj Urban Aboriginal Ear Health program
In Australian Aboriginal and Torres Strait Islander (hereafter respectfully referred to as “Aboriginal”) children, OM occurs at a younger age. The prevalence is higher and hearing loss and serious complications more common than in non-Aboriginal children.
Most Aboriginal people live in urban centres. Despite this, data on the burden of OM and hearing loss in urban Aboriginal children is limited. This project was initiated following a request from urban Aboriginal people who felt the focus on more remote communities often meant urban communities were forgotten.
Djaalinj Waakinj (Noongar for listening talking) was initiated in 2017 by discussions with Aboriginal community members, and Aboriginal health researchers. It is an ongoing study being conducted in South Metropolitan areas of Perth on Noongar Boodja (country).
Aboriginal researchers visit people’s homes to collect sociodemographic and environmental data at enrolment of babies under three months; otoscopy and tympanometry are conducted by an Aboriginal research assistant or a nurse at ages 2-4, 6–8 and 12–18 months, and full audiological assessment conducted at 9-12 months. This is the first cohort study of the prevalence and risk factors associated with OM in Aboriginal infants residing in an urban area.
As at the end of February 2020, 125 participants have been enrolled – 39% of 71 children aged 2-4 months and 52% of 44 children aged 6-8 months had evidence of OM.
The Djaalinj Waakinj project was the catalyst for a range of other Aboriginal ear health projects designed to translate research directly into policy and practice, including the evaluation of a telehealth program to reduce wait times for specialist treatment. The project has played a key role in the development of the WA Child Ear Health Strategy and will be provide the first prevalence and risk factor data for young urban Aboriginal children.
Children with OM are referred to the Cockburn Integrated Health (CIH) ENT clinic. CIH is a not-for-profit integrated health service established to meet the needs of the population in Cockburn and the surrounding communities. Telethon Kids Institute (TKI) and Moorditj Koort Aboriginal Health organises the monthly clinics. Telethon Speech and Hearing and Hearing Australia provide audiological support.
The author and fellow ENT surgeon Dr Francis Lannigan clinically assess these children and those requiring surgery are referred to PCH.
Charity program
The current wait-time for specialist treatment for OM can be lengthy. Hearing loss if not treated early can result in significant long-term issues with language, behavioural and educational development, as well as poor mental health outcomes and job prospects later in life.
Djaalinj Waakinj was born as a novel collaboration to provide essential ear surgery for Aboriginal children. The charity, the first of its kind in Australia, stands as an excellent example of public-private partnership, translation of policy into practice and health care benefits for these children.
In 2019, the author and St John of God Murdoch Hospital collaborated with TKI to provide access for children needing grommet surgery at no cost to their families as nominated Charity of the Year. The program has been well supported by the hospital, caregivers and South Metropolitan communities. The program is now ongoing with 15 children per year benefiting.
There have already been positive outcomes from Djaalinj Waakinj. The strong relationships established with the local Aboriginal community and organisations provide a solid foundation on which to conduct research now and in the future.
Through community forums, attendance at local events and health promotion in schools there has been enhanced awareness about OM and its consequences.
Author competing interests – the author is involved with the clinical aspect of the program