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O'Neill S, Begg S, Hyett N, Spelten E. Primary Health Care Interventions for Potentially Preventable Ear, Nose, and Throat Conditions in Rural and Remote Areas: A Systematic Review. EAR, NOSE & THROAT JOURNAL 2024:1455613241245198. [PMID: 38646793 DOI: 10.1177/01455613241245198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Background:Primary and secondary level preventive primary health care programs providing early detection and timely management of ear, nose, and throat (ENT) conditions in rural and remote regions are fundamental to preventing downstream impacts on health, social, and educational outcomes. However, the range and quality of evidence is yet to be reviewed. Objectives: The study objectives were to identify and synthesize the evidence of primary health care interventions for detection and management of ENT conditions in rural and remote areas, and evaluate the quality of the research and effectiveness of interventions. Methods: A systematic literature search of 6 databases (February 2023). The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, and the quality appraisal of studies was evaluated using the Mixed Methods Appraisal Tool (initial screening questions: Are there clear research questions? Do the collected data allow to address the research questions?). Results: Ten studies met the inclusion criteria. The results describe interventions for detection and management of respiratory tract infections, otitis media, and ear disease in primary health care settings. No studies met the inclusion criteria for tonsillitis. The role of community-based programs and allied health workers in the detection and management of ENT conditions was found to be effective in rural and remote regions. Only 2 of the studies met the screening criteria for quality appraisal. Conclusions: The study findings may inform future programs and policy development to address detection and management of ENT conditions in rural and remote primary care settings, and supports the need for further research on innovative models of care targeting potentially preventable hospitalizations through primary and secondary level prevention.
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Affiliation(s)
- Susan O'Neill
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Stephen Begg
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Nerida Hyett
- Murray Primary Health Network, Bendigo, VIC, Australia
| | - Evelien Spelten
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
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Pokorny MA, Thorne PR, Whitfield BCS, Wilson WJ. Diagnostic and management plan concordance across advanced audiologists, paediatric audiologists and non-specialist ENT doctors. Int J Audiol 2024; 63:69-73. [PMID: 36384388 DOI: 10.1080/14992027.2022.2145515] [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: 06/09/2022] [Accepted: 10/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the concordance of advanced audiologists (AA), junior doctors (JD) and paediatric audiologists (PA) with an Ear, Nose and Throat (ENT) specialist on the diagnosis and management of children with middle ear or hearing concerns. DESIGN A clinical equivalence (concordance) study. STUDY SAMPLE Three AAs, five JDs, three PAs and one ENT specialist asynchronously reported diagnoses and management plans for ten, online paediatric cases consisting of video-otoscopic images and clinical findings. RESULTS For medical diagnosis, significant agreement with the ENT specialist was observed at moderate and near-perfect levels for two AAs (k = 0.561 and 0.815), moderate levels for four JDs (k = 0.5 to 0.603) and near-perfect level for one PA (k = 0.815). For management decisions, significant agreement with the ENT specialist was observed at substantial (k = 0.636) and near-perfect (k = 0.818) levels for two AAs, and at a moderate level (k = 0.538) for one PA. Within group inter-rater agreement for management plans was substantial for AAs and JDs, and moderate for PAs. CONCLUSIONS For children with middle ear disease or hearing concerns, AAs, JDs and PAs showed similar levels of agreement with an ENT specialist on diagnosis, but AAs were more likely than JDs or PAs to agree with an ENT specialist on management.
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Affiliation(s)
- Michelle A Pokorny
- Discipline of Audiology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Peter R Thorne
- Section of Audiology, School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, University of Auckland, Auckland, New Zealand
| | - Bernard C S Whitfield
- Logan Hospital Integrated Specialist ENT Service, Metro South Health Service District, Queensland Health, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Wayne J Wilson
- Discipline of Audiology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, 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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4
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Habib AR, Perry C, Crossland G, Patel H, Kong K, Whitfield B, North H, Walton J, Da Cruz M, Suruliraj A, Smith M, Harris R, Hasan Z, Gunaratne DA, Sacks R, Singh N. Inter-rater agreement between 13 otolaryngologists to diagnose otitis media in Aboriginal and Torres Strait Islander children using a telehealth approach. Int J Pediatr Otorhinolaryngol 2023; 168:111494. [PMID: 37003013 DOI: 10.1016/j.ijporl.2023.111494] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/07/2023] [Accepted: 02/19/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Telehealth programs are important to deliver otolaryngology services for Aboriginal and Torres Strait Islander children living in rural and remote areas, where distance and access to specialists is a critical factor. OBJECTIVE To evaluate the inter-rater agreement and value of increasing levels of clinical data (otoscopy with or without audiometry and in-field nurse impressions) to diagnose otitis media using a telehealth approach. DESIGN Blinded, inter-rater reliability study. SETTING Ear health and hearing assessments collected from a statewide telehealth program for Indigenous children living in rural and remote areas of Queensland, Australia. PARTICIPANTS Thirteen board-certified otolaryngologists independently reviewed 80 telehealth assessments from 65 Indigenous children (mean age 5.7 ± 3.1 years, 33.8% female). INTERVENTIONS Raters were provided increasing tiers of clinical data to assess concordance to the reference standard diagnosis: Tier A) otoscopic images alone, Tier B) otoscopic images plus tympanometry and category of hearing loss, and Tier C) as B plus static compliance, canal volume, pure-tone audiometry, and nurse impressions (otoscopic findings and presumed diagnosis). For each tier, raters were asked to determine which of the four diagnostic categories applied: normal aerated ear, acute otitis media (AOM), otitis media with effusion (OME), and chronic otitis media (COM). MAIN OUTCOME MEASURES Proportion of agreement to the reference standard, prevalence-and-bias adjusted κ coefficients, mean difference in accuracy estimates between each tier of clinical data. RESULTS Accuracy between raters and the reference standard increased with increased provision of clinical data (Tier A: 65% (95%CI: 63-68%), κ = 0.53 (95%CI: 0.48-0.57); Tier B: 77% (95%CI: 74-79%), 0.68 (95%CI: 0.65-0.72); C: 85% (95%CI: 82-87%), 0.79 (95%CI: 0.76-0.82)). Classification accuracy significantly improved between Tier A to B (mean difference:12%, p < 0.001) and between Tier B to C (mean difference: 8%, p < 0.001). The largest improvement in classification accuracy was observed between Tier A and C (mean difference: 20%, p < 0.001). Inter-rater agreement similarly improved with increasing provision of clinical data. CONCLUSIONS There is substantial agreement between otolaryngologists to diagnose ear disease using electronically stored clinical data collected from telehealth assessments. The addition of audiometry, tympanometry and nurse impressions significantly improved expert accuracy and inter-rater agreement, compared to reviewing otoscopic images alone.
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Affiliation(s)
- Al-Rahim Habib
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, 2145, Australia.
| | - Chris Perry
- University of Queensland Medical School, St Lucia, Queensland, 4072, Australia
| | - Graeme Crossland
- Royal Darwin Hospital, Top End Health Service, Department of Health, Tiwi, Northern Territory, 0810, Australia
| | - Hemi Patel
- Royal Darwin Hospital, Top End Health Service, Department of Health, Tiwi, Northern Territory, 0810, Australia
| | - Kelvin Kong
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Bernard Whitfield
- Griffith Medical School, Griffith University, Southport, Queensland, 4215, Australia
| | - Hannah North
- Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, 2145, Australia
| | - Joanna Walton
- Department of Otolaryngology - Head and Neck Surgery, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia
| | - Melville Da Cruz
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, 2145, Australia
| | - Anand Suruliraj
- Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, 2145, Australia
| | - Murray Smith
- Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, 2145, Australia
| | - Rhydian Harris
- Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, 2145, Australia
| | - Zubair Hasan
- Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, 2145, Australia
| | - Dakshika A Gunaratne
- Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, 2145, Australia
| | - Raymond Sacks
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia
| | - Narinder Singh
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, 2145, Australia
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Alenezi EMA, Jajko K, Reid A, Locatelli-Smith A, Tao KFM, Bright T, Richmond PC, Eikelboom RH, Brennan-Jones CG. The reliability of video otoscopy recordings and still images in the asynchronous diagnosis of middle-ear disease. Int J Audiol 2021; 61:917-923. [PMID: 34596478 DOI: 10.1080/14992027.2021.1983217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the asynchronous assessment of video otoscopic still images to recordings by an audiologist and ear, nose and throat surgeon (ENT) for diagnostic reliability and agreement in identifying middle-ear disease. DESIGN A prospective cross-sectional study, asynchronously assessing video otoscopy, tympanometry and case history (Dx1). A subset was re-diagnosed (Dx2). STUDY SAMPLE Video otoscopy and data from 146 children recruited at two public community events; a sub-set of 47 were re-assessed. RESULTS The intra-rater diagnostic agreement between Dx1 and Dx2 was moderate (k = 0.445-0.552) for the ENT surgeon, and almost-perfect (k = 0.928) for the audiologist, in both procedures. The agreement between the two procedures was substantial (k = 0.624) and moderate (k = 0.416) for the ENT surgeon in Dx1 and Dx2 respectively, and almost-perfect for the audiologist (k = 0.854-0.978) in both rounds. In Dx1, the inter-rater agreement between the clinicians was substantial using still images (k = 0.672) and moderate using recordings (k = 0.593); in Dx2 it was moderate using both procedures (k = 0.477-0.488). CONCLUSION Both video otoscopic procedures, in addition to tympanometry and case history information, can be reliably used for asynchronous diagnosis of childhood middle-ear disease. An audiologist has a potential role in triaging children with middle-ear abnormalities and, therefore, improving access to ear-health services.
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Affiliation(s)
- Eman M A Alenezi
- Division of Paediatrics, The University of Western Australia, Nedlands, Western Australia.,Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia
| | - Kathryn Jajko
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia
| | - Allison Reid
- Division of Ear, Nose, and Throat, Perth Children's Hospital, Perth, Western Australia
| | | | - Karina F M Tao
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia
| | - Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel St, London
| | - Peter C Richmond
- Division of Paediatrics, The University of Western Australia, Nedlands, Western Australia.,Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia.,Division of Ear, Nose, and Throat, Perth Children's Hospital, Perth, Western Australia
| | - Robert H Eikelboom
- Department of Clinical Research, Ear Science Institute Australia, Subiaco, Western Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia.,Department of Speech Language Pathology and Audiology, University of Pretoria, South Africa.,Faculty of Health Sciences, Curtin University, Perth, Western Australia
| | - Christopher G Brennan-Jones
- Division of Paediatrics, The University of Western Australia, Nedlands, Western Australia.,Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia.,Division of Ear, Nose, and Throat, Perth Children's Hospital, Perth, Western Australia.,Faculty of Health Sciences, Curtin University, Perth, Western Australia
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Harding G, Hu N, Larter N, Montgomery A, Stephensen J, Callaghan L, Zwi K, Lingam R, Woolfenden S. Health status and health service use of urban Aboriginal children attending an Aboriginal community child health service in Sydney. J Paediatr Child Health 2021; 57:1072-1077. [PMID: 33629409 DOI: 10.1111/jpc.15403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Abstract
AIM There is limited information on the health status of urban Australian Aboriginal children and young people attending community-based child health services. Such information is vital to plan appropriate services. The objective of the study is to describe the health status and service use of children and young people presenting to an urban Aboriginal Community Paediatric Service in Sydney, Australia. METHODS Cross-sectional analysis of routinely collected data extracted from electronic medical records and the Australian Immunisation Register for urban Aboriginal children and young people aged 0-18 years who visited the service between January 2013 and December 2017. RESULTS A total of 273 Aboriginal children and young people had 609 occasions of service. Almost all (97.35%) were fully immunised. Forty-six percent of occasions of service noted >3 diagnoses; 55% of the consultations were for mental health and behavioural disorders. The most frequent diagnoses were speech and language delay, attention deficit hyperactivity disorder and school difficulty. Psychosocial concerns were noted in 61.2% of occasions of service, and 19.4% of children had a history of prematurity. Eighty-five percent of consultations had an onward referral to additional services. The most common referrals were for audiology, ear-nose and throat specialists and speech therapy. There were low numbers of referrals to mental health services relative to the high number of mental health diagnoses. CONCLUSION It is essential that we address the mental, developmental and psychosocial needs of Aboriginal children and young people who attend urban Community Child Health services. Integrated service models should be developed in partnership with Aboriginal community to do this.
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Affiliation(s)
- Georgia Harding
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Nan Hu
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Natasha Larter
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Alicia Montgomery
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Jennifer Stephensen
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Lola Callaghan
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Karen Zwi
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Sue Woolfenden
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
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Sharma M, Darke A, Wigglesworth G, Demuth K. Dichotic listening is associated with phonological awareness in Australian aboriginal children with otitis media: A remote community-based study. Int J Pediatr Otorhinolaryngol 2020; 138:110398. [PMID: 33152986 DOI: 10.1016/j.ijporl.2020.110398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Recent literature has highlighted a link between hearing loss as a result of otitis media in the early years of life and impacted binaural processing skills in later childhood. Such findings are of particular relevance to Indigenous Australian children, who tend to experience otitis media earlier in life and for longer periods than their non-Indigenous counterparts. There is also growing interest in the effects of reduced auditory processing ability on a child's early learning of language and, specifically, on phonological awareness that contributes to word reading skills. The aim of the present study was to determine the association between hearing thresholds, dichotic listening skills and phonological awareness in children with pervasive otitis media (OM) from remote Indigenous communities of Australia who generally do not speak English as a first language. METHODS Participants included one hundred and one children between the ages of 4.8-7.9 years (mean 6.1 years) from three separate remote Northern Territory communities. Evaluations included otoscopy, air conduction PTA, and tympanometry. All children were also assessed on the Dichotic Digits difference test (DDdT) and the Foundations of Early Literacy Assessment (FELA), assessing children's dichotic listening and phonological awareness respectively. RESULTS The results showed that 56% of the children had middle ear dysfunctions (type B and type C on tympanometry results) in at least one ear on the day. Partial correlation showed a significant correlation, between dichotic scores and FELA with age as covariate (r = 0.45, p < 0.001). One way ANOVA showed females exhibited a significantly higher performance compared to males on FELA [F (1, 99) = 5.47, p = 0.021]. The overall regression model was found to be significant in predicting total FELA scores [F (7, 77) = 7.56, p < 0.0005]. Age and gender as well as dichotic listening scores explain 40.7% of the variance. CONCLUSIONS The results reinforce the importance of managing the ear health of Indigenous children, clarifying the impact this has on listening and phonological awareness. These findings highlight the importance of evaluating children's listening abilities, and how poor listening can impact phonological awareness. The findings have important implications for ensuring optimal listening and learning conditions in schools in remote NT communities.
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Affiliation(s)
- Mridula Sharma
- Department of Linguistics, Macquarie University, Sydney, Australia.
| | - Amelia Darke
- Department of Linguistics, Macquarie University, Sydney, Australia.
| | - Gillian Wigglesworth
- School of Languages and Linguistics, University of Melbourne, Parkville, Australia; ARC Centre for Excellence for the Dynamics of Language, University of Melbourne, Parkville, Australia.
| | - Katherine Demuth
- Department of Linguistics, Macquarie University, Sydney, Australia; ARC Centre for Excellence in Cognition and Its Disorders, Macquarie University, Sydney, Australia.
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Artificial intelligence to detect tympanic membrane perforations. The Journal of Laryngology & Otology 2020; 134:311-315. [PMID: 32238202 DOI: 10.1017/s0022215120000717] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To explore the feasibility of constructing a proof-of-concept artificial intelligence algorithm to detect tympanic membrane perforations, for future application in under-resourced rural settings. METHODS A retrospective review was conducted of otoscopic images analysed using transfer learning with Google's Inception-V3 convolutional neural network architecture. The 'gold standard' 'ground truth' was defined by otolaryngologists. Perforation size was categorised as less than one-third (small), one-third to two-thirds (medium), or more than two-thirds (large) of the total tympanic membrane diameter. RESULTS A total of 233 tympanic membrane images were used (183 for training, 50 for testing). The algorithm correctly identified intact and perforated tympanic membranes (overall accuracy = 76.0 per cent, 95 per cent confidence interval = 62.1-86.0 per cent); the area under the curve was 0.867 (95 per cent confidence interval = 0.771-0.963). CONCLUSION A proof-of-concept image-classification artificial intelligence algorithm can be used to detect tympanic membrane perforations and, with further development, may prove to be a valuable tool for ear disease screening. Future endeavours are warranted to develop a point-of-care tool for healthcare workers in areas distant from otolaryngology.
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Leach AJ, Homøe P, Chidziva C, Gunasekera H, Kong K, Bhutta MF, Jensen R, Tamir SO, Das SK, Morris P. Panel 6: Otitis media and associated hearing loss among disadvantaged populations and low to middle-income countries. Int J Pediatr Otorhinolaryngol 2020; 130 Suppl 1:109857. [PMID: 32057518 PMCID: PMC7259423 DOI: 10.1016/j.ijporl.2019.109857] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE: Summarise the published evidence on otitis media and associated hearing loss in low to middle-income countries (LMIC) and disadvantaged populations. DATA SOURCES: PubMed and other databases. REVIEW METHODS: Firstly, sensitive search strategy using ‘otitis media’, combined with specific key words for each topic of the review, from January 2015 to June 2019. Then, restriction to LMIC and disadvantaged populations. Topics covered included prevention, epidemiology, risk factors, microbiology, prognosis, diagnosis, and treatment. CONCLUSIONS: There was a high degree of methodological heterogeneity and high risk of bias. The majority of studies were school-based. In Africa, Asia and Oceania (e.g., Australian Aboriginal populations) the prevalence of OM was respectively 8% (range 3–16%), 14% (range 7–22%) and 50% (4–95%). Prevalence of any hearing loss in these regions was 12% (range 8–17%), 12% (range 3–24%), and 26% (range 25–28%) respectively. Risk factors in LMIC and disadvantaged populations included age, gender, exposure to smoke and pollution. Microbiology was reported for otitis media with effusion at time of surgery or ear discharge (acute otitis media with perforation or chronic suppurative otitis media). Specimen handling and processing in hospital laboratories was associated with low detection of S. pneumoniae and H. influenzae. Case series described complicated cases of OM due to M. tuberculosis, multidrug resistance and HIV. QOL studies identified discrimination of persons with OM and hearing loss. Diagnostic methods varied greatly, from naked eye to tympanometry. Treatment interventions were reported from four RCTs. Non-RCTs included evaluations of guidelines, surgery outcomes, access to ENTs. IMPLICATIONS FOR CLINICAL PRACTICE: Chronic suppurative otitis media, otitis media with effusion and conductive hearing loss are common in LMIC and disadvantaged populations. Paucity of research, poor regional representation, non-standardised methods and low-quality reporting preclude accurate assessment of disease burden in LMIC and disadvantaged populations. Awareness and adherence to reporting Guidelines should be promoted.
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Affiliation(s)
- Amanda Jane Leach
- Menzies School of Health Research, John Mathews Building 58, Royal Darwin Hospital Campus, Rocklands Dr, Tiwi, NT, 0810, Australia.
| | - Preben Homøe
- Køge University Hospital, Copenhagen, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Clemence Chidziva
- University of Zimbabwe, Department of Surgery, 630 Churchill Avenue, Harare, Zimbabwe.
| | - Hasantha Gunasekera
- University of Sydney, Australia; The Children's Hospital at Westmead, Cnr Hawkesbury Rd &, Hainsworth St, Westmead, NSW, 2145, Australia.
| | - Kelvin Kong
- John Hunter Children's Hospital, Newcastle, Australia; Hunter ENT, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
| | - Mahmood F Bhutta
- Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK.
| | - Ramon Jensen
- Dept of Oto-rhino-laryngology and Audiology, F 2071 Rigshospitalet, Blegdamsvej 9, DK, 2100, Denmark; Department of Clinical Medicine, Blegdamsvej 3, 2200, København, Denmark.
| | - Sharon Ovnat Tamir
- Dept of OTO-HNS, Samson Assuta Ashdod University Hospital, Ashdod, Israel; Department of Otolaryngology-Head and Neck Surgery, Assuta University Hospital, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel.
| | - Sumon Kumar Das
- Menzies School of Health Research, John Mathews Building 58, Royal Darwin Hospital Campus, Rocklands Dr, Tiwi, NT, 0810, Australia.
| | - Peter Morris
- Menzies School of Health Research, John Mathews Building 58, Royal Darwin Hospital Campus, Rocklands Dr, Tiwi, NT, 0810, Australia; Royal Darwin Hospital, Rocklands Dr, Tiwi, NT, 0810, Australia.
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Mealings K, Harkus S, Flesher B, Meyer A, Chung K, Dillon H. Detection of hearing problems in Aboriginal and Torres strait islander children: a comparison between clinician-administered and self-administrated hearing tests. Int J Audiol 2020; 59:455-463. [PMID: 32011198 DOI: 10.1080/14992027.2020.1718781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: This study evaluated the agreement of self-administered tests with clinician-administered tests in detecting hearing loss and speech-in-noise deficits in Aboriginal & Torres Strait Islander children.Design: Children completed clinician-administered audiometry, self-administered automatic audiometry (AutoAud), clinician-administered Listening in Spatialised Noise - Sentences test and self-administered tablet-based hearing game Sound Scouts. Comparisons were made between tests to determine the agreement of the self-administered tests with clinician-administered tests in detecting hearing loss and speech-in-noise deficits.Study sample: Two hundred and ninety seven Aboriginal and Torres Strait Islander children aged 4-14 years from three schools.Results: Acceptable threshold differences of ≤5 dB between AutoAud and manual audiometry hearing thresholds were found for 88% of thresholds, with a greater agreement for older than for younger children. Consistent pass/fail results on the Sound Scouts speech-in-quiet measure and manual audiometry were found for 81% of children. Consistent pass/fail results on the Sound Scouts speech-in-noise measure and LiSN-S high-cue condition were found for 73% of children.Conclusions: This study shows good potential in using self-administered applications as initial tests for hearing problems in children. These tools may be especially valuable for children in remote locations and those from low socio-economic backgrounds who may not have easy access to healthcare.
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Affiliation(s)
| | | | - Brooke Flesher
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, USA
| | - Alea Meyer
- Department of Audiology, Northern Illinois University, DeKalb, IL, USA
| | - King Chung
- Department of Audiology, Northern Illinois University, DeKalb, IL, USA
| | - Harvey Dillon
- National Acoustic Laboratories, Sydney, Australia.,Division of Human Communication, Development and Hearing, University of Manchester, Manchester, UK.,Department of Linguistics, Macquarie University, Sydney, Australia
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Mealings K, Harkus S, Hwang J, Fragoso J, Chung K, Dillon H. Hearing loss and speech understanding in noise in Aboriginal and Torres Strait Islander children from locations varying in remoteness and socio-educational advantage. Int J Pediatr Otorhinolaryngol 2020; 129:109741. [PMID: 31677536 DOI: 10.1016/j.ijporl.2019.109741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Otitis media resulting in conductive hearing loss is a major health issue for Aboriginal and Torres Strait Islander children, which can also lead to the child developing spatial processing disorder (SPD). This study examined the prevalence of hearing loss and deficits in speech understanding in noise, including SPD, in Aboriginal and Torres Strait Islander children from schools varying in remoteness and socio-educational advantage. METHOD 288 Aboriginal and Torres Strait Islander children aged 4-14 years from three schools varying in remoteness and socio-educational advantage completed audiological assessment and the Listening in Spatialized Noise - Sentences test to assess for hearing loss and SPD. Children also completed Sound Scouts, a self-administered tablet-based hearing test which screens for these deficits. The prevalence of hearing issues was compared to what is expected from a typical population. RESULTS The proportion of children with hearing problems was related to the school's socio-educational advantage, with higher proportions in schools with a lower socio-educational advantage. Proportions of children with speech-in-noise deficits (including SPD) was related to the remoteness of the school, with higher proportions in schools that were more remote. CONCLUSIONS The prevalence of hearing loss and SPD is much higher in Aboriginal and Torres Strait Islander children than described for non-Aboriginal populations, and is related to the socio-educational advantage or remoteness of the school. Resources are needed to reduce the incidence of hearing loss and health disparity in Aboriginal communities, especially those in remote areas with lower socio-educational advantages.
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Affiliation(s)
| | | | | | | | - King Chung
- Northern Illinois University, United States
| | - Harvey Dillon
- National Acoustic Laboratories, Sydney, Australia; University of Manchester, Manchester, United Kingdom; Macquarie University, Sydney, Australia
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Chando S, Craig JC, Burgess L, Sherriff S, Purcell A, Gunasekera H, Banks S, Smith N, Banks E, Woolfenden S. Developmental risk among Aboriginal children living in urban areas in Australia: the Study of Environment on Aboriginal Resilience and Child Health (SEARCH). BMC Pediatr 2020; 20:13. [PMID: 31931753 PMCID: PMC6956483 DOI: 10.1186/s12887-019-1902-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/23/2019] [Indexed: 12/05/2022] Open
Abstract
Background Most Australian Aboriginal children are on track with their development, however, the prevalence of children at risk of or with a developmental or behavioural problem is higher than in other children. Aboriginal child development data mostly comes from remote communities, whereas most Aboriginal children live in urban settings. We quantified the proportion of participating children at moderate and high developmental risk as identified by caregivers’ concerns, and determined the factors associated with developmental risk among urban Aboriginal communities. Methods Study methods were co-designed and implemented with four participating urban Aboriginal Community Controlled Health Services in New South Wales, Australia, between 2008 and 2012. Caregiver-reported data on children < 8 years old enrolled in a longitudinal cohort study (Study of Environment on Aboriginal Resilience and Child Health: SEARCH) were collected by interview. The Parents’ Evaluation of Developmental Status (PEDS) was used to assess developmental risk through report of caregiver concerns. Odds ratios (OR) were calculated using multinomial logistic regression to investigate risk factors and develop a risk prediction model. Results Of 725 children in SEARCH with PEDS data (69% of eligible), 405 (56%) were male, and 336 (46%) were aged between 4.5 and 8 years. Using PEDS, 32% were at high, 28% moderate, and 40% low/no developmental risk. Compared with low/no risk, factors associated with high developmental risk in a mutually-adjusted model, with additional adjustment for study site, were male sex (OR 2.42, 95% confidence intervals 1.62–3.61), being older (4.5 to < 8 years versus < 3 years old, 3.80, 2.21–6.54), prior history of ear infection (1.95, 1.21–3.15), having lived in 4 or more houses versus one house (4.13, 2.04–8.35), foster care versus living with a parent (5.45, 2.32–12.78), and having a caregiver with psychological distress (2.40, 1.37–4.20). Conclusion In SEARCH, 40% of urban Aboriginal children younger than 8 years were at no or low developmental risk. Several factors associated with higher developmental risk were modifiable. Aboriginal community-driven programs to improve detection of developmental problems and facilitate early intervention are needed.
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Affiliation(s)
| | - Jonathan C Craig
- University of Sydney, Sydney, Australia.,Flinders University, Adelaide, Australia
| | - Leonie Burgess
- Sax Institute, Sydney, Australia.,Australian National University, Canberra, Australia
| | - Simone Sherriff
- University of Sydney, Sydney, Australia.,Sax Institute, Sydney, Australia
| | | | - Hasantha Gunasekera
- University of Sydney, Sydney, Australia.,Sydney Children's Hospitals Network, Sydney, Australia
| | - Sandra Banks
- Tharawal Aboriginal Medical Service, Campbelltown, Australia
| | - Natalie Smith
- Riverina Medical and Dental Corporation, Wagga Wagga, Australia
| | - Emily Banks
- Australian National University, Canberra, Australia
| | - Sue Woolfenden
- Sydney Children's Hospitals Network, Sydney, Australia. .,University of New South Wales, School of Women and Children's Health, Sydney, Australia.
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Thompson GN, Gee C, Talley Ac NJ. Indigenous health: one gap is closed. Med J Aust 2018; 209:14-15. [PMID: 29954307 DOI: 10.5694/mja18.00483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/17/2018] [Indexed: 11/17/2022]
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