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


CONCLUSIONS
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.
Morris
Peter S
PS
Ear Health and Education Unit, Menzies School of Health Research, Darwin, Australia. peterm@menzies.edu.au
Leach
Amanda J
AJ
Silberberg
Peter
P
Mellon
Gabrielle
G
Wilson
Cate
C
Hamilton
Elizabeth
E
Beissbarth
Jemima
J
D001315:Australia / Q000453:epidemiology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000145:classification / Q000208:ethnology*; D015995:Prevalence; D012423:Rural Health / Q000706:statistics & numerical data; D018058:Tympanic Membrane Perforation / Q000208:ethnology*