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Clinical guidelines

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people Second edition

Overview

Author Dr Sophie Couzos
Expert reviewers Associate Professor Amanda Leach, Associate Professor Peter Morris

Overview

The National Guide provides recommendations on the primary prevention of otitis media as a cause of hearing loss, and the early detection of hearing loss predominantly for children aged less than 15 years with some recommendations pertaining to Aboriginal and Torres Strait Islander adults. The diagnosis and management of otitis media and hearing loss is outside the scope of this guide, as other sources of advice are available.1,2

Children

Ear infections are more common in Aboriginal and Torres Strait Islander children than in non-Indigenous Australian children, and the chronic and suppurative consequences represent a major public health problem. Chronic otitis media such as otitis media with effusion and chronic suppurative otitis media are highly prevalent in rural and remote Aboriginal communities. These infections occur predominantly in Aboriginal children and cause hearing loss during the critical period of child development, although some effects may be lifelong. Otitis media is managed at a rate of 4 times for every 100 consultations in Aboriginal Community Controlled Health Services. In comparison, acute otitis media is less commonly managed in private general practice (1.2 per 100 encounters  2004–05) where over 98% of patients were non-Indigenous.3

Other guidelines

This National Guide has cross referenced recommendations in this section with the 2011 evidence based Recommendations for clinical care guidelines on the management of otitis media.2

Adults

Few recent studies have examined the extent of hearing impairment in Aboriginal and Torres Strait Islander adults. A 2006 cross sectional analysis of at least 50% of the adult Aboriginal prisoner population in Victoria showed no difference in the prevalence value for conductive hearing impairment between Aboriginal prisoners and a UK age-matched cohort (6.3% compared to 6.8% adults in the age group 18–40 years, respectively).4 Overall, self reported rates of hearing problems/ear diseases were 12% (across all ages) in the National Aboriginal and Torres Strait Islander Health Survey (2004–05), consistent with reporting by non-Indigenous people in the National Health Survey (13%). However, self reported rates of Aboriginal people’s hearing problems/ear disease were higher than the non-Aboriginal population for all ages, except for the population aged over 55 years of age.5 

Other guidelines

The 7th edition of the RACGP Guidelines for preventive activities in general practice recommends annual questioning about hearing impairment for Australians aged 65 years and over (B) and references the US Preventive Services Task Force (1996) and Canadian Task Force (1995).6 In 1996, the US task force recommended ‘screening older adults for hearing impairment by periodically questioning them about their hearing, counselling them about the availability of hearing aid devices, and making referrals for abnormalities when appropriate (B recommendation)’. In 2011, the US task force could not ascertain the benefits of screening and treatment for hearing loss in older adults (>50 years) and recommended more research. The review aimed to determine if screening for hearing loss in asymptomatic adults (>50 years) lead to improved health outcomes. However, it found that hearing ‘screening was not associated with any differences in hearing-related quality of life compared with no screening’.7 

References

  1. Antibiotic Expert Group. Therapeutic guidelines: antibiotic. Version 14. Melbourne: Therapeutic Guidelines Limited, 2010. Cited October 2011. Available at www.tg.org.au/?sectionid=41.
  2. Darwin Otitis Guideline Group in collaboration with the Office for Aboriginal and Torres Strait Islander Health Otitis Media Technical Advisory Group. Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations. Canberra: Office of Hearing Services and the Office for Aboriginal and Torres Strait Islander Health, Australian Government Department of Health and Ageing, 2010.
  3. Couzos S, Metcalf S, Murray R. Ear Health. Aboriginal Primary Healthcare: An Evidence-based Approach. South Melbourne: Oxford University Press, 2008, p.308–54.
  4. Quinn S, Rance G. The extent of hearing impairment among Australian Indigenous prisoners in Victoria, and implications for the correctional system. Int J Audiol 2009;48(3):123–34.
  5. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey, 2004–2005, cat. no. 4715. Canberra: ABS, 2006.
  6. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice (red book), 7th edn. Melbourne: RACGP, 2009. Cited October 2011. Available at www.racgp.org.au/ your-practice/guidelines/ redbook/.
  7. Chou R, Dana T, Bougatsos C, Fleming C, Bei T. Screening for hearing loss in adults ages 50 years and older: a review of the evidence for the US Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services, 2011.
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