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Bhutta MF, Leach AJ, Brennan-Jones CG. Chronic suppurative otitis media. Lancet 2024; 403:2339-2348. [PMID: 38621397 DOI: 10.1016/s0140-6736(24)00259-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/12/2023] [Accepted: 02/08/2024] [Indexed: 04/17/2024]
Abstract
Chronic suppurative otitis media (CSOM) is a leading global cause of potentially preventable hearing loss in children and adults, associated with socioeconomic deprivation. There is an absence of consensus on the definition of CSOM, which complicates efforts for prevention, treatment, and monitoring. CSOM occurs when perforation of the tympanic membrane is associated with severe or persistent inflammation in the middle ear, leading to hearing loss and recurrent or persistent ear discharge (otorrhoea). Cholesteatoma, caused by the inward growth of the squamous epithelium of the tympanic membrane into the middle ear, can also occur. The optimal treatment of discharge in CSOM is topical antibiotics. In resource-limited settings where topical antibiotics might not be available, topical antiseptics are an alternative. For persistent disease, surgery to repair the tympanic membrane or remove cholesteatoma might offer long-term resolution of otorrhoea and potential improvement to hearing. Recent developments in self-fitted air-conduction and bone-conduction hearing aids offer promise as new options for rehabilitation.
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Affiliation(s)
- Mahmood F Bhutta
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, UK; Department of ENT, Royal Sussex County Hospital, Brighton, UK.
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Darwin, NT, Australia
| | - Christopher G Brennan-Jones
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Ear Health Group, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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Harkus S, Marnane V, O'Keeffe I, Kung C, Ward M, Orr N, Skinner J, Hughes JK, Fonua Wiradjuri L, Kennedy Wiradjuri M, Kong Worimi K, Belfrage M. Development of the national consensus statement on ear health and hearing check recommendations for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: systematic scoping review and e-Delphi. BMC PRIMARY CARE 2024; 25:86. [PMID: 38486181 PMCID: PMC10938761 DOI: 10.1186/s12875-024-02307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Early detection of long-term, often asymptomatic, middle ear infection in young Aboriginal and Torres Strait Islander children is more likely to be achieved when ear health and hearing checks are routinely undertaken in primary healthcare. Evidence consistently demonstrates the adverse impacts of this condition on the development and wellbeing of children and their families. We aimed to develop feasible, evidence- and consensus-based primary healthcare recommendations addressing the components and timing of ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years, not already known to have, nor being actively managed for, ear and hearing problems. METHODS A 22-person working group comprising Aboriginal and Torres Strait Islander and non-Indigenous members from the primary healthcare, ear, hearing, and research sectors provided guidance of the project. A systematic scoping review addressed research questions relating to primary health ear health and hearing checks for Aboriginal and Torres Strait Islander and other populations at increased risk of persistent ear health problems. Twelve primary studies and eleven guidelines published between 1998 and 2020 were identified and reviewed. Quality and certainty of evidence and risk of bias ratings were completed for studies and guidelines. In the absence of certain and direct evidence, findings and draft recommendations were presented for consensus input to a 79-member expert panel using a modified e-Delphi process. Recommendations were finalised in consultation with working group members and presented to expert panel members for input on considerations relating to implementation. RESULTS Overall, the quality, certainty, and directness of evidence in the studies and guidelines reviewed was low. However, the findings provided a basis and structure for the draft recommendations presented during the consensus-building process. After two e-Delphi rounds, seven goals and eight recommendations on the components and timing of Ear Health and Hearing Checks in primary healthcare for young Aboriginal and Torres Strait Islander children were developed. CONCLUSIONS The systematic scoping review and consensus-building process provided a pragmatic approach for producing strong recommendations within a reasonably short timeframe, despite the low quality and certainty of evidence, and paucity of studies pertaining to primary healthcare settings.
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Affiliation(s)
| | | | | | | | - Meagan Ward
- National Acoustic Laboratories, Sydney, Australia
| | - Neil Orr
- Macquarie University, Sydney, Australia
| | | | | | | | | | | | - Mary Belfrage
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
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Nash K, Gwynne K, Dimitropoulos Y, Fitzpatrick M, Gunasekera H, Halvorsen L, Kong K, Lumby N, Macniven R, Parter C, Wingett A, McMahon C. INdigenous Systems and Policies Improved and Reimagined for Ear and hearing care (INSPIRE): a multi-method study protocol. BMJ Open 2024; 14:e079850. [PMID: 38199621 PMCID: PMC10806583 DOI: 10.1136/bmjopen-2023-079850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Otitis media (middle ear disease) severity and chronicity among Aboriginal and Torres Strait Islander people, as well as gaps in socioeconomic outcomes related to hearing loss, indicates a breakdown in the current ear and hearing care system. The ear and hearing care system spans multiple sectors due to long-term impacts of otitis media and hearing loss in health, education and employment, necessitating a multi-disciplinary cross-sectorial approach to ear and hearing care. Public policies shape the current ear and hearing care system and here it is argued that a critical public policy analysis across different sectors is needed, with strong Aboriginal and Torres Strait Islander leadership and guidance. The current study aims to establish consensus-based ear and hearing care policy solutions for Aboriginal and Torres Strait Islander people in Australia. METHODS AND ANALYSIS This multi-method study will be guided by a Brains Trust with strong Aboriginal and Torres Strait Islander leadership. Public policies in hearing health, social services, and education will be scoped to identify policy gaps, using the World Health Organization framework. Qualitative data will be collected through a culturally specific process of yarning circles to identify policy challenges and/or limitations in enabling accessible ear and hearing care programs/services for Aboriginal and Torres Strait Islander people, using dimensions of Morestin's public policy appraisal tool as an interview guide for stakeholders. Themes from the yarning circles will be used to inform an expert Delphi process to establish consensus-based policy solutions for optimising the ear and hearing care system for Aboriginal and Torres Strait Islander people. ETHICS AND DISSEMINATION This study has approval from the Australian Institute of Aboriginal and Torres Strait Islander Studies Ethics Committee. Study findings will be disseminated to community through Brains Trust members and study participants, as well as through publications in peer-reviewed journals and research forum presentations.
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Affiliation(s)
- Kai Nash
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Kylie Gwynne
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Dimitropoulos
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mark Fitzpatrick
- Telethon Speech and Hearing, Perth, Western Australia, Australia
| | | | - Luke Halvorsen
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Kelvin Kong
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Noeleen Lumby
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Rona Macniven
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Carmen Parter
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Amanda Wingett
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Catherine McMahon
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Veselinović T, Weeks SA, Swift VM, Morrison NR, Doyle JE, Richmond HJ, Alenezi EMA, Tao KFM, Richmond PC, Choi RSM, Mulders WHAM, Goulios H, Lehmann D, Brennan-Jones CG. Ear and hearing outcomes in Aboriginal infants living in an urban Australian area: the Djaalinj Waakinj birth cohort study. Int J Audiol 2023:1-9. [PMID: 37694733 DOI: 10.1080/14992027.2023.2252177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Describe the ear and hearing outcomes in Aboriginal infants in an Australian urban area. DESIGN Aboriginal infants enrolled in the Djaalinj Waakinj prospective cohort study had ear health screenings at ages 2-4, 6-8 and 12-18 months and audiological assessment at ∼12 months of age. Sociodemographic, environmental characteristics, otoscopy, otoacoustic emissions, tympanometry and visual reinforcement audiometry data were collected. STUDY SAMPLE 125 infants were enrolled in the study; 67 completed audiological assessment, 62, 54, and 58 of whom attended ear screenings at 2-4, 6-8 and 12-18 months. RESULTS Of the children that attended the audiological assessment, 36.5%, 50% and 64.3% of infants had otitis media (OM) at 2-4, 6-8 and 12-18 months. Using a 10 dB correction factor, 44.8% of infants had hearing loss (HL) (≥ 25 dB HL) at ∼ 12 months of age. More males (X2=5.4 (1df, p = 0.02)) and infants with OM at audiological assessment (X2=5.8 (1df, p = 0.02)) had HL. More infants that used a pacifier at 12-18 months of age had HL (X2=4.7 (1df, p = 0.03)). CONCLUSION Aboriginal infants in an urban area have high rates of HL and OM, which requires early surveillance and timely treatment to reduce the medical and developmental impacts of OM and HL.
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Affiliation(s)
- Tamara Veselinović
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Sharon A Weeks
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Valerie M Swift
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Natasha R Morrison
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - June E Doyle
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Holly J Richmond
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Eman M A Alenezi
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Faculty of Allied Health Sciences, Kuwait University, Kuwait City, Kuwait
| | - Karina F M Tao
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Discipline of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
| | - Robyn S M Choi
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- School of Human Sciences, The University of Western Australia, Perth, Australia
| | | | - Helen Goulios
- School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Christopher G Brennan-Jones
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
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DeLacy J, Burgess L, Cutmore M, Sherriff S, Woolfenden S, Falster K, Banks E, Purcell A, Kong K, Coates H, Curotta J, Douglas M, Slater K, Thompson A, Stephens J, Sherwood J, McIntyre P, Tsembis J, Dickson M, Craig J, Gunasekera H. Ear health and hearing in urban Aboriginal children. Aust N Z J Public Health 2023; 47:100075. [PMID: 37517360 DOI: 10.1016/j.anzjph.2023.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/17/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE Evaluate ear health and hearing among urban Aboriginal children and quantify relationships with child, family and social factors. METHODS Baseline questionnaire and ear health examinations from 1430 children with diagnoses (0.5-18 years) attending Aboriginal Health Services enrolled in SEARCH. Ear health outcomes were Otitis Media (OM), and hearing loss (three-frequency average hearing loss >20dB) diagnosed using pneumatic otoscopy, tympanometry, and audiometry. RESULTS Half the children 0.5-3 years had OM (51.5%, 136/264). One third 0.5-18 years (30.4%; 435/1430) had OM, including 1.8% (26/1430) with perforation (0.8% chronic suppurative OM, 0.6% dry perforation and 0.4% acute OM with perforation). One quarter 0.5-18 years (25.7%; 279/1087) had hearing loss; 12.4% unilateral, 13.2% bilateral (70.6% with bilateral loss had concurrent OM). OM was associated with: younger age (0.5-<3 years versus 6-18 years) age-sex-site; adjusted prevalence ratio (aPR)=2.64, 95%, 2.18-3.19); attending childcare/preschool (aPR=1.24, 95%CI, 1.04-1.49); foster care (aPR=1.40, 95%CI, 1.10-1.79); previous ear infection/s (aPR=1.68, 95%CI, 1.42-1.98); and ≥2 people/bedroom (aPR=1.66, 95%CI, 1.24-2.21). Hearing impairment was associated with younger age (0.5-<6 years vs. ≥6 years aPR=1.89, 95%CI, 1.40-2.55) and previous ear infection (aPR=1.87, 95%CI, 1.31-2.68). CONCLUSIONS Half the urban Aboriginal children in this cohort had OM and two-thirds with hearing impairment had OM. IMPLICATIONS FOR PUBLIC HEALTH Findings highlight importance of early detection and support for ear health, particularly in pre-school-aged children with risk factors.
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Affiliation(s)
- Jack DeLacy
- The University of Sydney, Sydney, NSW, Australia; Children's Hospital at Westmead, Sydney, NSW, Australia; The Sax Institute, Sydney, NSW, Australia.
| | | | | | - Simone Sherriff
- The University of Sydney, Sydney, NSW, Australia; The Sax Institute, Sydney, NSW, Australia
| | | | | | - Emily Banks
- Australian National University, Canberra, ACT, Australia
| | | | - Kelvin Kong
- Newcastle Private Medical Suites, Newcastle, NSW, Australia
| | - Harvey Coates
- University of Western Australia, Perth, WA, Australia
| | | | | | - Kym Slater
- Tharawal Aboriginal Corporation, Sydney, NSW, Australia
| | - Aleathia Thompson
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, NSW, Australia
| | | | | | | | | | | | | | - Hasantha Gunasekera
- The University of Sydney, Sydney, NSW, Australia; Children's Hospital at Westmead, Sydney, NSW, Australia
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