Researchers gathered at the OMOZ (Otitis Media Australia) 2024 conference in Newcastle to hear the latest research and brainstorm ideas for improving ear and hearing health for children. More than 300 people attended the conference which was a sold out success, writes SHARRON HALL, research manager, Aboriginal Ear Health, Hunter Medical Research Institute.
Sixty per cent by 60 days of age. That is the proportion of Northern Territory Aboriginal babies who were found to carry bacterial strains in their nasal passages that can spread to the middle ear, causing otitis media (OM) and hearing loss in early childhood.
These alarming figures were brought to the attention of the medical community in 1994 when Professor Amanda Leach AM from Menzies School of Health Research published the results of her PhD thesis. It is now 30 years since that initial revelation. What has changed?
The message from researchers who gathered on Awabakal and Worimi lands at the 7th OMOZ conference in Newcastle, NSW, is that early onset and persistence of ear infections and hearing loss remain major health issues today, especially for Indigenous communities. Conference host, Professor Kelvin Kong AM, an ear, nose and throat (ENT) surgeon and proud Worimi man, calls hearing loss a developmental emergency that drives entrenched disadvantage.
The conference, which attracts an eclectic group of registrants, is the premier meeting for Indigenous Health Practitioners, community members, researchers, clinicians, paediatricians, surgeons, audiologists and allied health practitioners investigating and treating chronic ear disease in Australia. Normally held every two years since the inaugural meeting in 2010, the conference location moves to a different city each time.
From an attendance of 70 people in Darwin in 2010, the 2024 delegation has grown to approximately 320 people from all walks of life and many cities and towns across Australia. The 2024 delegation has grown to approximately 320 people from all walks of life and many cities and towns across Australia. The conference survived lockdown through being hosted online by a team of researchers at The Kids Research Institute (formerly Telethon Kids Institute) in Perth.
The 2024 meeting, at Newcastle City Hall, brought old and new friends together in a joyful union of Aboriginal and Torres Strait Islander and non-Aboriginal researchers committed to improving hearing health outcomes for all children.
Central to the purpose of the OMOZ conference is the importance of being inclusive and respectful of Aboriginal and Torres Strait Islander knowledge and culture. The meeting began on 27 August with a ‘Mob Only’ day for about 70 Aboriginal and Torres Strait Islander delegates to get to know one another. This informal discussion of health issues, work practices and other topics of importance aimed to achieve the best ear health outcomes for their communities.
A highlight was a walk to Newcastle Harbour foreshore where local Awabakal man, Mr Ray Kelly Jnr, recounted the Aboriginal history of the region through storytelling handed down over generations.
The main conference social event was on the sand dunes at Birubi Beach on the Worimi Conservation Lands and Murrook Culture Centre, which is north of Newcastle.
The conference program from 28 to 30 August featured keynote speakers and workshops, before delegates attended sessions.
Challenges accessing ENT pathways
A familiar theme throughout many presentations centred on challenges parents and carers of children face in accessing a specialist ENT pathway when concerned about their children’s ear health, hearing loss, speech development, behaviour problems, poor school attendance and performance.
According to research findings, the difficulties result from issues ranging from long wait times for appointments to clinicians’ uncertainty in detection, diagnosis and treatment of acute and chronic otitis media and needing to travel long distances to ENT service providers.
In the absence of early childhood screening programs, it is possible for hearing loss to go unnoticed in the developmental years.
Presenters found ear infections and hearing loss occur at increased rates in low socioeconomic urban communities, which often have higher populations of Indigenous Australians, as was seen in urban areas of NSW, WA and SA. In some studies, this can be correlated with crowded housing.
The OMOZ 2024 guest speaker, Dr Shelly Chadha, was the World Health Organization representative responsible for work undertaken by WHO to improve global outcomes on prevention of hearing loss. Trained in India as an ENT specialist, Dr Chadha spoke of the isolation and educational barriers experienced by those living with hearing loss.
She recalled her sadness, as a young medical resident, when asked to treat a girl who had attempted suicide because her ear infection in both ears meant she couldn’t go to school or make friends.
Hearing loss the tip of the iceberg
Dr Chadha likened the global extent of hearing loss to an iceberg, which can appear to be of a certain size on the ocean surface but is much greater in size underwater. She said one billion people were at risk of hearing loss worldwide and warned that, each year, the cost of not delivering adequate hearing health care adds up to one trillion dollars globally.
What can be done to achieve better outcomes in ear and hearing health? Researchers at the conference reported innovative ideas and evidenced-based practice to guide practitioners as well as policy makers in positive directions.
Local communities provide an excellent starting point for problem-solving that makes a real difference. Knowledge of families and aspects of community life that facilitate health promotion and cultural safety for Indigenous people create enablers that break down barriers to health care access. This can be as straightforward as providing transport for vital medical appointments or as subtle as understanding and helping to overcome an individual patient’s personal circumstances that might stand in the way of receiving necessary ear health interventions. In Dr Chadha’s words, “Think globally, act locally.”
Workforce training
Workforce training is another important piece of the solution. It takes time, resources, skill development and practice to be able to differentiate signs of chronic ear disease, hearing problems or developmental delay in young children. The beauty of investing in ear health training is that capacity to improve detection and diagnosis of ear or hearing problems can be built into many tiers of health service, from the local community health worker to the clinical practitioner or emergency doctor.
Having a trained workforce on the ground in rural and remote regions means people living away from metropolitan areas receive culturally safe ear and hearing primary health care, reducing the need to travel big distances or wait so long for specialist appointments. The meeting discussed the many ways to reduce impediments and delays to ear and hearing health care access but there is so much work to be done.
Technological advances from using artificial intelligence algorithms for describing an image of the ear drum, to growing ear tissue cells artificially in a test tube, are promising new directions from data experts, audiologists and scientists worldwide.
Bacterial ‘slime’ hides from antibiotics
Australian researchers are among the leaders tracking the bacteria responsible for ear infections and conducting clinical trials of vaccines made available over the years. WA scientists have explored the mysterious properties of biofilm, the bacterial ‘slime’ that infections can create, demonstrating the intriguing way bacteria can ‘hide’ from effects of antibiotics.
Researchers and remote communities of the NT have run trials of vaccines with potential to protect against some highly infectious strains of bacteria, such as the common Pneumococcal species and H. influenzae that can cause ear disease in children.
During the COVID-19 pandemic years, the increased use of telemedicine made a positive impact on improving access to specialist ENT care in several jurisdictions. For those with the skills to use a video-otoscope and tympanometer, which allows the capture of images and tests vibration of the ear drum, results can be transmitted electronically for viewing by an ENT specialist in a metropolitan centre. This strategy has improved opportunities for rural patients to be seen quickly and locally by a trained ear health care worker who can place them on their pathway to better hearing outcomes.
The OMOZ 2024 conference proved that ear and hearing health research has greatly strengthened in Australia but we are standing on the tip of the iceberg. Much more needs to be done and more support is needed from government, health services, policy makers and medical institutions to ensure our research findings translate into far greater awareness and effective practice.
For the conference host, Professor Kelvin Kong, the goal is for all Australian children, both Indigenous and non-Indigenous, to have the same chance of having healthy ears and normal hearing, no matter where they live in Australia.
