Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 1—Human function—1.15 Ear health

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

Why is it important?:

Hearing loss among Aboriginal and Torres Strait Islander peoples is widespread and much more common than for non-Indigenous Australians. The most common causes of hearing loss among Indigenous Australians are disorders of the middle ear, specifically bacterial and viral infections leading to otitis media.

Hearing loss, especially in childhood, can lead to linguistic, social and learning difficulties and behavioural problems in school. Such differences may reduce educational achievements and have life-long consequences for employment, income, social success and contact with the criminal justice system (Williams et al. 2009). The negative effects are likely to be compounded for Indigenous children, many of whom have to adapt to an educational environment where the language and/or culture differs from that of their home (Australian Indigenous HealthInfoNet 2004).

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 suppurative otitis media is a perforation in the eardrum and active bacterial infection within the middle ear space which lasts 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 2004a). Data from the NT on a subset of children receiving audiology services show that the rate of chronic suppurative otitis media was 12%. Several other studies have found that Aboriginal and Torres Strait Islander children living in remote communities experience severe and persistent ear infections. These occur earlier in life compared with non-Indigenous children (Morris et al. 2007; Gunasekera et al. 2009). The prevalence of otitis media is 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 peoples 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, lower rates of breastfeeding, nutritional deficiencies and lack of access to primary health care and treatment.

Findings:

National survey data rely on self-report of conditions that have been diagnosed by a doctor and therefore may under-count the prevalence of conditions in the population. For example, the 2008 NATSISS found that 12% of Aboriginal and Torres Strait Islander children in the NT had ear/hearing problems, while ear disease was found in 30% of the 10,605 Aboriginal and Torres Strait Islander children tested in prescribed areas (remote areas and town camps) between July 2007 and 30 June 2009 as part of the Northern Territory Emergency Response (NTER). Of the nearly 5,000 children who received audiology services as part of the NTER, two-thirds had at least one middle ear condition, 53% were found to have hearing loss, 33% had hearing impairment and almost 12% had chronic suppurative otitis media. Data from programs specifically targeting otitis media in rural and remote areas such as the Deadly Ears Program in Qld show significantly higher prevalence than national survey data.

In the 2004–05 NATSIHS, 12% of Aboriginal and Torres Strait Islander peoples reported ear and hearing problems. Hearing loss was higher than for non-Indigenous Australians in all age groups from 0–54 years of age. In the 2008 NATSISS, 9% of Aboriginal and Torres Strait Islander children aged 0–14 years were reported to have ear/hearing problems, 3 times the rate for non-Indigenous children. Rates were higher in remote areas (10%) compared with non-remote areas (8%). The NT had the highest rate of child hearing problems and Victoria the lowest.

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% without smokers).Top of page

Hospitalisation rates for all ear disease combined for Aboriginal and Torres Strait Islander peoples was around 1.3 times the non-Indigenous rate in the period July 2008 to June 2010. While rates for Aboriginal and Torres Strait Islander children aged 0–4 years were less than those for non-Indigenous children, the rate for Indigenous children aged 5–14 years was twice as high. There has been no significant change in Indigenous hospitalisation rates for ear disease over the long term (since 1998–99), however there was an increase in recent years (2004–05 to 2009–10).

In 2009–10, the rate of myringotomy procedures (incision in the eardrum to relieve pressure caused by excessive fluid build-up) in hospital was lower for Indigenous Australians (1.4 per 1,000) than for non-Indigenous Australians (1.7 per 1,000), although the gap was smaller than in 2007–08. Indigenous Australians were 20% less likely to undergo this procedure (SCRGSP 2011a). In the period from July 2008 to June 2010, Indigenous children aged 0–14 years were hospitalised for tympanoplasty procedures (a reconstructive surgical treatment for a perforated eardrum) at 7.3 times the rate of other children.

BEACH survey data collected from April 2006 to March 2011 suggest that the rate of problems managed by GPs among Indigenous children aged 0–14 years were 1.1 times the non-Indigenous rate for otitis media/myringitis and 1.2 times the non-Indigenous rate for total diseases of the ear.

Implications:

Chronic ear disease causing serious hearing damage is common among Aboriginal and Torres Strait Islander peoples. Chronic suppurative otitis media occurs in some Aboriginal and Torres Strait Islander communities at levels described as a massive public health problem requiring urgent action (WHO 2004a).

The prevalence of ear disease is significantly higher for Aboriginal and Torres Strait Islander peoples, yet some levels of treatment by GPs for Indigenous children are similar to those for other Australian children. The rates of tympanoplasty procedures in hospitals were higher and myringotomy rates were lower than for other children. Evidence suggests that a comprehensive approach combining early treatment, management and referral, linkages with school screening programs, preventative (including nutritional), social, environmental and economic strategies will be most successful in addressing the high rates of chronic otitis media.Top of page

Funding totalling $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 Aboriginal and Torres Strait Islander peoples suffering avoidable hearing loss, improve the coordination of hearing health care, and give Indigenous children a better start to education. Key activities include a national social marketing campaign—Care for Kids' Ears; training of Aboriginal Health Workers in ear and hearing health; provision of ear and hearing equipment to primary health care services; funding to states and territories for additional ear surgery, Ear, Nose and Throat services and clinical leadership activities; updating and distributing the Recommendations for Clinical Care Guidelines on the Management of Otitis Media in Aboriginal and Torres Strait Islander Populations; and working with the Australian Medicare Locals Alliance to implement the updated Guidelines in general practice.

In Qld, the Deadly Ears Program has been established to address middle ear disease, including screening services, health promotion, training, and the delivery of allied health, clinical and surgical services.

In 2011–12 the Australian Government provided $2.311 million for the Australian Hearing Specialist Program for Indigenous Australians (AHSPIA). AHSPIA is Australian Hearing's outreach service, designed to meet the varying and complex audiological needs of clients in remote Indigenous communities. A further $2.149 million was provided to Australian Hearing to provide hearing services for eligible Indigenous Australians over 50 years of age. In addition, the National Acoustics Laboratory has committed to a research project to establish the prevalence of spatial listening disorder among Indigenous Australian children in selected remote community schools in the NT, and selected primary schools in metropolitan Sydney. The disorder is thought to affect the listening and therefore learning ability of school aged children, and may be more prevalent in children with an existing hearing loss. This work is ongoing.Top of page
Figure 56—Age-standardised hospitalisation rates for diseases of the ear and mastoid process, by age and Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, 2004–05 to 2009–10
Figure 56—Age-standardised hospitalisation rates for diseases of the ear and mastoid process, by age and Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, 2004–05 to 2009–10
Source: AIHW analysis of National Hospital Morbidity Database.
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Figure 57—Ear and hearing problems managed by GPs, by Indigenous status of patients aged 0-14 years, April 2006–March 2007 to April 2010–March 2011
Figure 57—Ear and hearing problems managed by GPs, by Indigenous status of patients aged 0-14 years, April 2006–March 2007 to April 2010–March 2011
Source: AIHW analysis of BEACH survey of general practice, AGPSCC
Table 15—Diseases of the ear and mastoid reported for Aboriginal and Torres Strait Islander children aged 0–14 years, by remoteness and sex, 1995(a), 2001, 2004–05 and 2008
1995—Males
%
1995—Females
%
1995—Persons
%
2001—Males
%
2001—Females
%
2001—Persons
%
2004–05—Males
%
2004–05—Females
%
2004–05—Persons
%
2008—Males
%
2008—Females
%
2008—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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