Absent otoacoustic emissions predict otitis media in young Aboriginal children: a birth cohort study in Aboriginal and non-Aboriginal children in an arid zone of Western Australia.

Deborah Lehmann,Ruth Monck,Annette Stokes,Janine Finucane,Dimity Elsbury,Sharon Weeks,Peter Jacoby,Harvey Coates

doi:10.1186/1471-2431-8-32

Abstract

BackgroundOtitis media (OM) is the most common paediatric illness for which antibiotics are prescribed. In Australian Aboriginal children OM is frequently asymptomatic and starts at a younger age, is more common and more likely to result in hearing loss than in non-Aboriginal children. Absent transient evoked otoacoustic emissions (TEOAEs) may predict subsequent risk of OM.Methods100 Aboriginal and 180 non-Aboriginal children in a semi-arid zone of Western Australia were followed regularly from birth to age 2 years. Tympanometry was conducted at routine field follow-up from age 3 months. Routine clinical examination by an ENT specialist was to be done 3 times and hearing assessment by an audiologist twice. TEOAEs were measured at ages <1 and 1–2 months. Cox proportional hazards model was used to investigate the association between absent TEOAEs and subsequent risk of OM.ResultsAt routine ENT specialist clinics, OM was detected in 55% of 184 examinations in Aboriginal children and 26% of 392 examinations in non-Aboriginal children; peak prevalence was 72% at age 5–9 months in Aboriginal children and 40% at 10–14 months in non-Aboriginal children. Moderate-severe hearing loss was present in 32% of 47 Aboriginal children and 7% of 120 non-Aboriginal children aged 12 months or more.TEOAE responses were present in 90% (46/51) of Aboriginal children and 99% (120/121) of non-Aboriginal children aged <1 month and in 62% (21/34) and 93% (108/116), respectively, in Aboriginal and non-Aboriginal children at age 1–2 months. Aboriginal children who failed TEOAE at age 1–2 months were 2.6 times more likely to develop OM subsequently than those who passed.Overall prevalence of type B tympanograms at field follow-up was 50% (n = 78) in Aboriginal children and 20% (n = 95) in non-Aboriginal children.ConclusionThe burden of middle ear disease is high in all children, but particularly in Aboriginal children, one-third of whom suffer from moderate-severe hearing loss. In view of the frequently silent nature of OM, every opportunity must be taken to screen for OM. Measurement of TEOAEs at age 1–2 months to identify children at risk of developing OM should be evaluated in a routine health service setting.

Highlights

Otitis media (OM) is the most common paediatric illness for which antibiotics are prescribed
The burden of middle ear disease is high in all children, but in Aboriginal children, one-third of whom suffer from moderate-severe hearing loss
Measurement of transient evoked otoacoustic emissions (TEOAEs) at age 1–2 months to identify children at risk of developing OM should be evaluated in a routine health service setting

Summary

Introduction

Otitis media (OM) is the most common paediatric illness for which antibiotics are prescribed. In Australian Aboriginal children OM is frequently asymptomatic and starts at a younger age, is more common and more likely to result in hearing loss than in non-Aboriginal children. In industrialised countries otitis media (OM) is the most common paediatric illness for which medical advice is sought and antibiotics are prescribed [1]. OM incidence peaks at age 6– 18 months and 3–17% of children suffer ≥ 3 attacks of acute OM annually. There are no populationbased data on the burden of OM in the general population of Australia other than a nationwide study conducted 30 years ago [5]

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