SPECTRUM AND MANAGEMENT OF OTITIS MEDIA IN AUSTRALIAN INDIGENOUS AND NON-INDIGENOUS CHILDREN: A NATIONAL STUDY

Abstract

INTRODUCTION: The reported prevalence and severity of otitis media are highest among the world's Indigenous children, but whether their clinical management varies accordingly is unknown. OBJECTIVE: Our aim was to study the spectrum and management of otitis media in Indigenous and non-Indigenous children in Australia. METHODS: From a representative Australian cluster survey of consecutive primary health care consultations, we analyzed all consultations with children (aged 0–18 years). We compared the practitioners' investigation, treatment, and referral practices for Indigenous and non-Indigenous children with otitis media after adjusting for clustering. RESULTS: Over 8 years (1998–2006), 7991 practitioners managed 141 693 problems in 119 503 consultations with children, including 2856 (2.4%) with Indigenous children. Ear problems were the fourth most common problems managed. Otitis media was managed slightly more commonly in Indigenous than non-Indigenous children (9.8% vs 7.3% consultations; P < .05). When otitis media was diagnosed, Indigenous children were significantly more likely to have severe otitis media (chronic and/or suppurative and/or perforation: 7.9% vs 1.7%; P < .001), discharging ears (3.9% vs 0.1%; P < .001), ear swabs (3.9% [95% confidence interval (CI): 1.6–6.2] vs 0.8% [95% CI: 0.6–0.9]), and topical eardrops administered (10.7% [95% CI: 6.8–14.6] vs 4.5% [95% CI: 4.1–5.0]) but not more likely to receive oral antibiotics (71.8% vs 75.9%), have ear syringing (1.1% vs 0.2%), or be referred to an otolaryngologist (6.1% vs 3.4%) or audiologist (1.8% vs 1.1%) (all P > .05). CONCLUSIONS: In the Australian primary health care setting, Indigenous children are 5 times more likely to be diagnosed with severe otitis media than non-Indigenous 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.