Aboriginal and Torres Strait Islander Health Performance Framework - 2010

1.12 Children's hearing loss

Page last updated: 26 May 2011

Why is it important?:

Hearing loss among Aboriginal and Torres Strait Islander children is widespread and much more common than in the broader Australian population. The most common causes of hearing loss among Aboriginal and Torres Strait Islander peoples are disorders of the middle ear, specifically bacterial and viral infections leading to otitis media.

Otitis media is an inflammation of the middle ear. Otitis media with effusion involves a collection of fluid that occurs within the middle ear space, and chronic suppur-ative otitis media involves a perforation (hole) in the eardrum and active bacterial infection within the middle ear space for several weeks or more. The World Health Organization regards a prevalence of chronic suppurative otitis media of greater than 4% as a massive public health problem requiring urgent action (WHO 2004). Several studies have found Aboriginal and Torres Strait Islander children living in remote communities experience severe and persistent ear infections which occur earlier in life compared with non-Indigenous children (Morris et al. 2007; Gunasekera et al. 2009), with prevalence of otitis media as high as 70% in some remote communities (Coates 2009).

Otitis media is thought to be more common and severe among Aboriginal and Torres Strait Islander children because of poverty, crowded housing conditions, inadequate access to water and to functioning sewerage and waste-removal systems (increasing the risk of bacterial and viral infections), passive smoking, nutritional problems and lack of access to primary health care and treatment.

Hearing loss can lead to linguistic, social and learning difficulties and behavioural problems in school, which reduce educational achievements that have life-long consequences for employment, income, and social success (Williams & Jacobs 2009).

Tympanoplasty is a reconstructive surgical treatment for a perforated eardrum. There is some international evidence that early access to tympanoplasty for otitis media with effusion does not have a beneficial effect on developmental outcomes (Berman 2007; Paradise et al. 2007), although the implications of this evidence for Indigenous children, who experience early and more severe conditions, is not clear.

Findings:

Findings from the 2008 NATSISS suggest 9% of Aboriginal and Torres Strait Islander children aged under 15 years had ear or hearing problems reported by their parent or carer. Around 3% of these children were reported to have complete or partial deafness or hearing loss and the same proportion were reported to have otitis media. Comparative data from 2004–05 shows that Indigenous children were 3 times as likely to have reported ear or hearing problems compared with other Australian children.

Hearing health varies by remoteness. In 2008 10% of Aboriginal and Torres Strait Islander children living in remote areas were reported to have ear or hearing problems compared with 8% of Indigenous children in non-remote areas. The Northern Territory had the highest rate of child hearing problems (12%) and Victoria the lowest (6%).

Programs specifically targeting otitis media in rural and remote areas such as the Deadly Ears Program in Queensland show significantly higher prevalence than national survey data.

The NATSIHS confirms the associations between the presence of ear or hearing problems and social conditions. For example, in 2004–05, ear/hearing problems were more common for children living in overcrowded households (15% versus 8%), those living in the most socioeconomically disadvantaged areas (15% versus 11% for the most advantaged areas) and those living in households with regular smokers (10% versus 8%).

The hospitalisation rate for all ear disease combined for Aboriginal and Torres Strait Islander children is estimated to be around 10% higher than for other Australian children, particularly in the 5–14 year age group. There has been a statistically significant decline in hospitalisations rates for Indigenous females and other Australian children between 2001–02 and 2007–08.

In the two-year period from July 2006 to June 2008, Aboriginal and Torres Strait Islander children aged 0–14 years were hospitalised for tympanoplasty procedures due to middle ear infection at 4 times the rate of other children. The rate of myringotomy procedures in hospital (incision in eardrum to relieve pressure caused by excessive build up of fluid) for Indigenous children (1.0 per 1,000) was lower than for non-Indigenous children (1.6 per 1,000) (COAG Reform Council 2010).

General practice attendances for acute otitis media or myringitis were similar for Aboriginal and Torres Strait Islander children (8 per 100 encounters) and other Australian children (7 per 100 encounters) from 2004–05 to 2008–09.

The 2008 NATSISS found 12% of Indigenous children in the Northern Territory had ear/hearing problems reported by their parent or carer. However, around 30% of 10,605 children were found to have ear disease between July 2007 and 30 June 2009, when Northern Territory Emergency Response Child Health Checks were undertaken in the prescribed areas (remote communities and town camps). Data on audiology services show that three-quarters of the 3,500 children who received an audiology test had at least one middle ear condition, 54% were found to have hearing loss, and almost 12% had chronic suppurative otitis media.

Implications:

Chronic ear disease causing serious hearing damage is common in Aboriginal and Torres Strait Islander children. Chronic suppurative otitis media occurs in some Aboriginal and Torres Strait Islander communities at levels described by the World Health Organization as a massive public health problem requireing urgent action (WHO 2004).

The prevalence of ear disease is significantly higher for Aboriginal and Torres Strait Islander children than other children in self-reported survey data, yet levels of treatment by GPs and levels of hospitalisation are similar to those of other Australian children. Only tympanoplasty procedures in hospitals are higher, although more research is needed on the effectiveness of this procedure. Evidence suggests that a comprehensive approach that combines early treatment, management and referral, linkages with school screening programs, preventative, social, environmental and economic strategies will be most successful in addressing these high levels of chronic otitis media.

Funding totaling $58.3 million for eye and ear health initiatives has been allocated over four years from 2009 under the Improving Eye and Ear Health Services for Indigenous Australians for Better Education and Employment Outcomes measure. The measure aims to reduce the number of Indigenous people suffering avoidable hearing loss, improve the coordination of hearing health care, and give Indigenous children a better start to education.

In 2010, the Australian Government funded the purchase and supply of ear and hearing equipment for Aboriginal Medical Services and commenced developmental work for training programs for ear and hearing health workers. The Recommendations for Clinical Care Guidelines on the Management of Otitis Media in Aboriginal and Torres Strait Islander Populations (OATSIH 2001) have also been funded.

Figure 33 – Hospitalisation rates for Aboriginal and Torres Strait Islander and other children aged 0–14 years from diseases of the ear and mastoid, Qld, WA, SA and NT, 2001–02 to 2007–08; NSW, Vic. Qld, WA, SA, NT 2004–05 to 2007–08


Figure 33 – Hospitalisation rates for Aboriginal and Torres Strait Islander and other children aged 0–14 years from diseases of the ear and mastoid, Qld, WA, SA and NT, 2001–02 to 2007–08; NSW, Vic. Qld, WA, SA, NT 2004–05 to 2007–08
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 33 (TXT 1KB)

Table 20 – Proportion of Indigenous children aged 0–14 years reporting ear/hearing problems, by type of problem, 2008

Type of ear/hearing problem
%
Does not have ear/hearing problems 91.4
Total has ear/hearing problems 8.6
Total or partial hearing loss 2.8
Runny ears or glue ear (Otitis media) 3.1
Other 2.7
Total(a) 100
Total number 191,543
Not known 1
(a) Excludes not known responses.
Source: AIHW analyses of 2008 National Aboriginal and Torres Strait Islander Social Survey

Table 21 – Diseases of the ear and mastoid reported for Aboriginal and Torres Strait Islander children aged 0–14 years, by remoteness and sex, 1995, 2001, 2004–05 and 2008

Remoteness status
1995
2001
2004-05
2008
Males
Females
Persons
Males
Females
Persons
Males
Females
Persons
Males
Females
Persons
%
%
%
%
%
%
%
%
%
%
%
%
Remote
n.a.
n.a.
n.a.
18
18
18
12
13
13
11
10
10
Non-remote
7
5
6
6
11
9
9
8
9
8
8
8
Total
n.a.
n.a.
n.a.
10
13
11
10
10
10
9
9
9
(a) Data for the National Aboriginal and Torres Strait Islander Health Survey 1995 areas available for non-remote areas only
Source: ABS & AIHW analysis of 1995 and 2001 National Health Survey (Indigenous supplements) ,2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2008 National Aboriginal and Torres Strait Islander Social Survey

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