Preventing hearing loss in pre-schoolers
Joining the dots to see the big picture and determine what is most important to improve child health is a task The Kids Research Institute Australia researchers do well.
Searching for a way to reduce debilitating hearing problems and associated learning difficulties in young Aboriginal children with the highest reported rates of otitis media (middle ear infections) worldwide, researchers “joined the dots” and revealed that overcrowding was a key problem.
The Kids researchers discovered that overcrowding is the strongest predictor of carriage of bacteria that cause otitis media, emphasising the need to improve housing conditions, specifically for Aboriginal people.
The finding came out of the Kalgoorlie Otitis Media Research Project, led by head researcher Professor Deborah Lehmann. Running from 1999 to 2005, it followed 100 Aboriginal children and 180 non-Aboriginal children from birth to 2-years-old to look at environmental, social and biological factors contributing to high rates of ear disease.
The only study worldwide to investigate these factors in Aboriginal and non-Aboriginal children living in the same geographic area, it was established when concerned Aboriginal leaders in the Goldfields approached then Institute Director Professor Fiona Stanley asking for help to find ways to improve educational and employment outcomes for their children by targeting otitis media.
Many pitched in to assist Professor Lehmann to “join the dots”. The team involved laboratory-based researchers, epidemiologists, nurses, paediatricians, ENT surgeons, audiologists, Aboriginal Health Workers and community members and organisations.
The research also revealed that in many children there were no obvious signs of middle ear infection until ears were “runny”, so families did not seek early treatment. By this stage, the disease was so severe that there was a hole in the eardrum and hearing loss.
Recognising it would take time and money to tackle overcrowding, the Institute researchers pushed on to develop an effective community-embraced ear health education program in an attempt to trigger significant improvements through health promotion, health checks and training of health workers. In this way, the Pina Palya, Pina Kulilku (Good Ears, Good Learning) program was born.
Passive smoking too was targeted, after also being identified in the Institute’s research as an important preventable risk factor for otitis media. Innovative health promotion programs to reduce exposure included the ‘Buyu’(smoke in Wongutha language) community arts project. Passive smoking is thought to increase the adherence of ear-damaging bacteria and depress immune function.
Aimed at children up to 5-years-old in the Goldfields, the highly creative Healthway-funded Pina Palya, Pina Kulilku program then used soap making workshops, Aboriginal musicals in schools, anti-germ jingles, a fluorescent hand washing teaching cream and a gigantic inflatable walk-through ‘Big Ear - Pina Purlka’ to promote the three key messages; keep cigarette smoke away from children, frequent hand washing and regular ear checks.
“Overall, the aim was to ensure the children could hear by the time they started school, “ said Professor Lehmann.
The project was a collaboration between The Kids Research Institute Australia, WA Country Health Services, the Rural Clinical School, Bega Garnbirrungu Aboriginal Health Services and Ngunytju Tjitji Pirni Inc.
It led to 357 ear checks in under 5-year-olds, older children and adults being screened opportunistically, 46 children being seen by an ENT specialist and Aboriginal Health Workers reporting they had gained confidence in examining ears. Also among community members there was increased knowledge about ear health and more smoking outside, rather than inside the house, and not in cars.
Otitis Media
Otitis media (middle ear infection) occurs when infection causes inflammation of the middle ear (the space behind the ear drum) and the eardrum.
Fluid can build up in the middle ear which can result in perforation of the ear drum. In severe cases of otitis media, grommets (small tubes) can be inserted in the ear drum to allow the fluid to drain.
Otitis media can seriously affect childhood development, school performance and subsequent social and economic wellbeing.
What’s next?
“We need to build an improved ear health program throughout WA and determine appropriateness of extending the Goldfields ear health program model to other parts of Western Australia, including the metropolitan area of Perth,” said Professor Lehmann.
“We also need to advocate for improved appropriate housing to reduce crowding and hold an ear health roundtable discussion bringing stakeholders from across WA.”