Recommendations for clinical care guidelines on the management of Otitis Media in Aboriginal and Torres Strait Islander Populations

Section C: Prognosis

Improve family understanding of the likely outcomes of illness to raise awareness and avoid possible adverse effects of persistent otitis media and persistent hearing loss

Page last updated: 14 October 2011

Improve family understanding of the likely outcomes of illness to raise awareness and avoid possible adverse effects of persistent otitis media and persistent hearing loss

DiagnosisRelevant InformationEvidence Studies Evidence -Based Guidelines
OMETell the families/caregivers that:
  • Persistent OME is a frequent complication of episodic OME or AOM in populations at high risk of CSOM (see definition).
II63;5;6I~A17;18
  • OME frequently resolves spontaneously within a 3 month period in populations at low risk of CSOM.
II107;108;5;6;25I~A17
  • Conductive hearing loss (CHL) in OME may be either ‘mild’ or ‘moderate’. It is expected to return to normal when middle ear effusion/fluid resolves. The average hearing loss associated with OME is around 25dB.
  • Hearing loss will be greater in bilateral OME, or where a fluid level or bubbles behind the TM are not visible.
II8;5;6;30I~A17
AOMTell the families/caregivers that:
  • AOM may occur as early as within the first few weeks of life. It is most often asymptomatic in populations at high risk of CSOM.

Discharge from the perforated eardrum may be the first sign of disease in this group of children.
I53;11;5;25;61
  • Spontaneous resolution of AOM to OME is much less likely in populations at high risk of CSOM.
II65;5;28
  • AOM frequently resolves spontaneously in populations at low risk of CSOM.
  • Mastoiditis, meningitis and cerebral abscess are all recognised complications of AOM, but are uncommon.
II30;5;28I~A16;19;14
AOMwiPTell the families/caregivers that:
  • In populations at low risk of CSOM, very few children develop spontaneous perforation of the TM.
II35;5;28
  • AOMwiP is a frequent occurrence in populations at high risk of CSOM. It may lead to CSOM if not treated appropriately.
I53;61;66;5
rAOMTell the families/caregivers that:
  • Recurrent or persistent AOM or AOMwiP in populations at high risk of CSOM is a condition that requires commitment and dedication to manage effectively.
III109
CSOMTell the families/caregivers that:
  • CSOM is difficult to treat in high risk populations. Management is long-term (often months) and aimed at reducing the incidence of permanent hearing disability and suppurative complications.
III7;27
  • In populations at low risk of CSOM, very few acute perforations progress to CSOM. In these populations, children more commonly develop CSOM as a complication of grommet insertion (tympanostomy tube) or underlying immunodeficiency.
III54;5;27;29
  • CHL associated with eardrum perforation may be as high as 60dB. The hearing loss depends on the size and position of the perforation and the amount of discharge.
III5;27;29
  • There is an increased risk of sensorineural hearing loss with recurrent or persistent CSOM.
II7;8;27
  • In combination with an underlying conductive loss, persistent CSOM can lead to a moderate to severe mixed hearing loss.
II7;8;27
Dry Perforation Tell the families/caregivers that:
  • People with dry perforations are at risk of further infections associated with new discharge. This can lead to CSOM.
Hearing Loss as a Consequence of OMTell the families/caregivers that:
  • All forms of OM can impair hearing. The degree of impairment depends on the disease state. The more persistent and severe the OM condition, the greater its effect upon hearing sensitivity and auditory-language development.
II6;27
  • Permanent CHL can occur as a result of recurrent, acute or chronic inflammation, TM perforation or adhesions, ossicular discontinuity, fixation or erosion.
II8;6;27
  • Some Indigenous Australian children with ‘mild’ conductive hearing loss are much more disadvantaged than other children.

Their hearing impairment may be exacerbated by:
  • very early onset
  • multiple language demands in the home environment
  • lack of access to pre-school
  • limited exposure to standard Australian English prior to school-entry
  • major grammatical and phonological differences between Indigenous Australian languages and standard English.
I~A21
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