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What is Otitis Media?
Many Aboriginal or Torres Strait Islander children, and almost all who live in remote communities, have middle ear infection, glue ear or runny ears (otitis media, OM). Children with OM cannot hear properly and have trouble with speech, language, learning and behaviour.
Otitis media (OM) refers to all forms of inflammation and infection of the middle ear, causing conductive hearing loss and communications problems.
What causes Otitis Media?
The germs called pneumococcus (pneumo) and non-typable H. influenzae (NTHi or H’flu) get into the baby or child’s nose from other children. These germs can then get inside the middle ear and cause infection and pus – like a boil – which can burst the ear drum. Unlike a boil under the skin which can heal, the eardrum can take a long time to heal and must be treated. Germs in the nose also go inside the chest to cause pneumonia.
Active inflammation or infection is nearly always associated with fluid in the middle ear space (a middle ear effusion). Bacteria that initially colonise the nose and nasopharynx get to the middle ear via the Eustachian tube. The host inflammatory response causes fluid to build up in the middle ear space, resulting in bulging of the eardrum which can be extremely painful. The eardrum may even burst. Otitis Media may also be present without noticeable symptoms and can persist for long periods undetected.
Funded By Northern Territory PHN
Steve Edwards – Art Direction, Animation & Editing
Michael Carella – Character Design and Animation
NT Hearing Services
Susan Clunies-Ross – Clinical Nurse Specialist
Tatenda Muridzi – Hearing Health Promotion Program Development Officer
Lucy Kellow – Hearing Heath Promotion Officer
Annie Taylor – Aboriginal Health Practitioner
Hima John – Audiologist
Vanessa Rotumah – Clinical Nurse Education Consultant
Leah Chynoweth – Family Educator – Families as First Teachers
Eileen Bonson – Community Hearing Worker
Voiceover by Jennifer Mary
Hazel Brown – mother’s voice
Davisiah Wilson-Dashwood – boys voice
Alex Clunies-Ross – teacher’s voice
Zahli Chynoweth – girls voice
Freesound.org licensed under Creative Commons
“Cracking Dry Wood” by Herbet Boland
“Techno drum loop” by Djfroyd
“Shuffling backwards on a carpet” by Pfranzen
“Baby sneeze sound” by Robinhood 76
“Blowing nose” by Mshahen
“Jazzgiggle-10-8-05(9mo)” by Levinj
“Babycry01” by Pfly (sampling+license)
Why worry about Otitis Media?
One of the most critical consequences of OM is its impact on hearing, and therefore communication (listening, talking).
Damage or disorders of the outer or middle parts of the ear affects the way that sound is carried, or conducted, through to the inner ear and the rest of the auditory system. Otitis media, which mainly affects children, is the most common cause of conductive hearing loss. Hearing loss associated with persistent middle ear infection during the early years of childhood impacts upon a child’s learning, language development and communication, and psychosocial development.
The child may experience speech delay, auditory processing disorder (APD), social isolation, and educational disadvantage. Children with hearing impairment are more likely to have experienced substantiated maltreatment. For families, otitis media may result in distress, time off from work for parents, visits to the doctor or clinic, and ongoing medical costs.
Otitis media affects a higher proportion of children who have contact with other children, such as in day care centres. Highest rates occur in communities where there is greater general disadvantage, such as in remote communities in the Northern Territory (NT). Conditions of overcrowded housing, poor nutrition, compromised hygiene, smoke exposure and limited access to quality, culturally safe, reliable primary health care can all be contributing factors to the prevalence of otitis media.
Otitis Media in Aboriginal and Torres Strait Children
Across Australia, including in urban areas of capital cities, otitis media is far more frequent and serious among Indigenous than non-Indigenous children. In fact, Indigenous Australian children have the highest reported rate of otitis media and burst ear drums in the world. While acute middle ear infections cause ear pain among non-Indigenous children, scientists have struggled to identify why the condition is generally not painful for many Indigenous children. Without the presence of ear pain, parents are unaware of their child’s infection and it progresses undetected, often resulting in perforated ear drums and chronic suppuratives otitis media (CSOM), known as runny ears. In the Northern Territory remote communities in 2013, 86% of Indigenous children below 3 years of age had some form of otitis media, 14% of these had a perforated ear drum. This contrasts with a national prevalence of just 0.1% among non-Indigenous children. In remote areas, otitis media begins within weeks of birth and persists for months or even years. In many of these remote communities, “runny ears” have become normalised.
Fortunately, our ongoing surveillance of otitis media in remote areas has found a consistent decline in the prevalence of CSOM among Indigenous children, from 24% in 2001 to 14% in 2012. While this constitutes a significant reduction, these prevalence rates are still extremely high. The World Health Organisation (WHO) considers that a 4% prevalence rate of CSOM constitutes a “public health emergency” requiring immediate attention. The prevalence rate amongst Australia’s Indigenous children therefore is startlingly higher than the WHO’s emergency levels.
For Indigenous children, the severity and duration of hearing loss experienced in early life is having a devastating impact on social development and educational achievement. Hearing loss impacts upon a child’s ability to connect with family members, play with friends, and develop academically. Young people with hearing loss may feel isolated from their peers and may find education frustrating and difficult. This may cause them to disengage from school, leave early and ultimately can get them into trouble with the youth justice system.
Several recent studies in the Northern Territory have found that around 90% of Indigenous prison inmates have significant hearing loss. Hearing impairment further affects comprehension of complex interactions with services and authorities, including hospitals, police and the criminal justice system. For many Indigenous people, English is a second language which poses a further challenge to communication with significant hearing loss.