title: The spectrum and management of otitis media in Australian indigenous and nonindigenous children: a national study.
abstract: BACKGROUND
  Indigenous children have the highest reported prevalence and severity of otitis media in the world, but whether their clinical management varies accordingly is unknown.
  
  
  METHODS
  Using a representative Australia-wide cluster survey of consecutive primary healthcare consultations, we compared practitioners' investigation, treatment, and referral practices for otitis media in indigenous and nonindigenous children (0-18 years), after adjusting for clustering.
  
  
  RESULTS
  Over 8 years (1998-2006), 7991 practitioners managed 141,693 problems during 119,503 consultations with children, including 2856 (2%) with indigenous children. Ear problems were the fourth most common problems managed overall, with otitis media seen more commonly in indigenous than in nonindigenous children (10% versus 7% consultations, P < 0.001). Indigenous children were significantly more likely to have severe otitis media (chronic and/or suppurative and/or perforation, 8% versus 2%, P < 0.001); discharging ears (4% versus 0.1%, P < 0.001); ear swabs [4%, 95% confidence interval (CI): 2%-6% versus 0.8%, 95% CI: 0.6%-0.9%]; and topical eardrops administered (11%, 95% CI: 7%-15% versus 5%, 95% CI: 4%-5%); but not more likely to receive oral antibiotics (72% versus 76%); have ear syringing (1% versus 0.2%); be referred to an otolaryngologist (6% versus 3%) or audiologist (2% versus 1%); all P > 0.05.
  
  
  CONCLUSIONS
  In the Australian primary healthcare setting, indigenous children are 5 times more likely to be diagnosed with severe otitis media than nonindigenous children, but reported management is not substantially different, which is inconsistent with established national guidelines. This spectrum-management discordance may contribute to continued worse outcomes for indigenous children with otitis media.
authors.affiliation: Centre for Kidney Research, The Children's Hospital, Westmead, Sydney, Australia. hasanthg@chw.edu.au
authors.forename: Hasantha
authors.initials: H
authors.lastname: Gunasekera
authors.forename: Stephanie
authors.initials: S
authors.lastname: Knox
authors.forename: Peter
authors.initials: P
authors.lastname: Morris
authors.forename: Helena
authors.initials: H
authors.lastname: Britt
authors.forename: Peter
authors.initials: P
authors.lastname: McIntyre
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001315:Australia; D002648:Child; D002675:Child, Preschool; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010033:Otitis Media / Q000453:epidemiology* / Q000628:therapy*; D010034:Otitis Media with Effusion / Q000453:epidemiology; D015995:Prevalence; D044469:Racial Groups; D012017:Referral and Consultation / Q000706:statistics & numerical data; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
chemical_list: D000900:Anti-Bacterial Agents