Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross-sectional survey

Peter S Morris, Amanda J Leach, Peter Silberberg, Gabrielle Mellon, Cate Wilson, Elizabeth Hamilton, Jemima Beissbarth, Peter S Morris, Amanda J Leach, Peter Silberberg, Gabrielle Mellon, Cate Wilson, Elizabeth Hamilton, Jemima Beissbarth

Abstract

Background: Middle ear disease (otitis media) is common and frequently severe in Australian Aboriginal children. There have not been any recent large-scale surveys using clear definitions and a standardised middle ear assessment. The aim of the study was to determine the prevalence of middle ear disease (otitis media) in a high-risk population of young Aboriginal children from remote communities in Northern and Central Australia.

Methods: 709 Aboriginal children aged 6-30 months living in 29 communities from 4 health regions participated in the study between May and November 2001. Otitis media (OM) and perforation of the tympanic membrane (TM) were diagnosed by tympanometry, pneumatic otoscopy, and video-otoscopy. We used otoscopic criteria (bulging TM or recent perforation) to diagnose acute otitis media.

Results: 914 children were eligible to participate in the study and 709 were assessed (78%). Otitis media affected nearly all children (91%, 95%CI 88, 94). Overall prevalence estimates adjusted for clustering by community were: 10% (95%CI 8, 12) for unilateral otitis media with effusion (OME); 31% (95%CI 27, 34) for bilateral OME; 26% (95%CI 23, 30) for acute otitis media without perforation (AOM/woP); 7% (95%CI 4, 9) for AOM with perforation (AOM/wiP); 2% (95%CI 1, 3) for dry perforation; and 15% (95%CI 11, 19) for chronic suppurative otitis media (CSOM). The perforation prevalence ranged from 0-60% between communities and from 19-33% between regions. Perforations of the tympanic membrane affected 40% of children in their first 18 months of life. These were not always persistent.

Conclusion: Overall, 1 in every 2 children examined had otoscopic signs consistent with suppurative ear disease and 1 in 4 children had a perforated tympanic membrane. Some of the children with intact tympanic membranes had experienced a perforation that healed before the survey. In this high-risk population, high rates of tympanic perforation were associated with high rates of bulging of the tympanic membrane.

Figures

Figure 1
Figure 1
Percentage of children examined with a perforation in each of the 29 communities at the time of examination. (Number at top of bar represents the total number of children examined).
Figure 2
Figure 2
Percentage of young children from remote communities in Northern and Central Australia with severe otitis media by health region (error bars represent 95% confidence intervals adjusted for the clustering effect of living in the same community).
Figure 3
Figure 3
Time in days to 1st perforation recorded in medical records in young Aboriginal children from 29 remote communities in Northern and Central Australia.

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