Skip links and keyboard navigation


Welcome to Deadly Ears


Middle Ear Disease

A middle ear disease is when there is inflammation in the middle ear. Sometimes this causes pain and/or fever, and sometimes there are no symptoms. It is caused by respiratory bacteria and viruses that have moved up the eustachian tube from the back of the nose.

The disease results in:

  • inflammation of the middle ear;
  • fluid accumulation in the middle ear space;
  • bulging of the ear drum; and
  • perforation of the ear drum.
Wiertsema SP, Leach AJ. Theories of otitis media pathogenesis, with a focus on Indigenous children. Med J Aust 2009 Nov 2;191(9 Suppl):S50-S54. 

This is a common short-term illness among all children. But Aboriginal and Torres Strait Islander children experience these diseases earlier, more frequently, more severely, and more persistently than other children.
Kong K, and Coates, H. Natural history, definitions, risk factors and burden of otitis media. Otitis Media 2009: An Update. Med J Aust. 2009; 191: s39-43.

The medical term for middle ear disease is otitis media, though many people might know of it as “glue ear”, or “runny ears” for really bad ear diseases.

Deadly Ears

Diagram of Middle Ear Disease

Middle Ear Disease

Middle ear disease starts with a build up of fluid behind the ear drum. It can lead to hearing loss if the problem continues or if not treated. Most importantly middle ear disease is preventable, treatable, and is not a normal part of a child's life.

Further information on middle ear fdisease is also available from Care for Kids Ears website:  

http://www.careforkidsears.health.gov.au/

Signs and Symptons

It is important to remember that sometimes there are no signs that a child has middle ear disease. This is why it is important to get their ears checked regularly.

The signs of middle ear disease may include one or more of the following:

  • Pulling at the ears
  • Redness of the ears
  • Fever
  • Complaint of ear pain
  • Discharge from ear
  • Dizzy / Clumsy
  • Congestion related to a cold
  • Grizzly / Grumpy
 

Sign of hearing loss associated with middle ear disease might include:

  • Decreased alertness
  • Asking to repeat things
  • Asking to turn sounds up
  • Signs of boredom
  • Watching others for cues
  • Poor concentration
  • Behaviour problems

What are the risk factors?

SDOH Model

Macro-Social Level: Influences that are developed and lead from a national and state perspective; factors typically driven by government priorities that are often the levers used to address the health needs of the population, improve equity and add quality to services and outcomes.

Community Level: Factors surrounding the individual in their immediate natural and build environment; factors that are not in the individual's control to influence but a person's access to these factors is paramount for these protective factors to be effective and enable an individual behavour to be carried out

Individual Behaviours: Individual behaviours that are required to protect ears and promote good hearing; behaviours that an individual has control over and the ability to directly influence.

The model is used by Dealy Ears to visually represent:

  • The many and varying protective factors required for a child to have healthy ears and good hearing and the complex inter-relationship they have with each other;
  • the many layers that have both an indirect and direct impact on a child and their ears and hearing, highlighting that health and ill-health have many more influences than just the presence of disease;
  • Why it is vital that ears and hearing is everyone's business and why we're all part of the solution.

 

 

Deadly Ears

There are also host risk factors:    

  • A key risk is simply being an Aboriginal and/or Torres Strait Islander child, who get middle ear disease earlier and more severely
    • One study showed some Aboriginal children can experience 32 months of middle ear disease between 2 and 20 years. In contrast, non-Indigenous children experience 3 months;
  • Young age – peaks are noticed between 6 & 12 months and 4 & 5 years:
    • Most likely to occur in first year of life, less common as kids get older;
    • The peak at 6-12 months is often associated with the end of breastfeeding;
    • The peak at 4-5 years is sometimes associated with increasing contact with other kids, like at kindy. But it could also be associated with child health checks occurring at this age and finding ear and hearing problems;
  • Family history – kids are more likely to have middle ear disease if their families have experienced it also;
  • Premature and low birthweight babies; and
  • Immunosuppression and poor nutrition.

A good summary is available from:
Kong K, and Coates, H. Natural history, definitions, risk factors and burden of otitis media. Otitis Media 2009: An Update. Med J Aust. 2009; 191: s37.
Also: Couzos S, Metcalf S, and Murray R. The systematic review of existing evidence and primary care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander Populations - March, 2001. OATSIH publications: Department of Health and Ageing. (Last accessed on 1st April 2010).
Also: World Health Organization. Chronic suppurative otitis media: burden of illness and management options. Geneva: WHO, 2004.
Available from URL: http://www.who.int/pbd/deafness/activities/hearing_care/otitis_media.pdf

How serious is the problem?

The World Health Organisation says:

  • The prevalance of chronic otitis media of greater than 1% in children indicates that there is an avoidable burden of the disease.
  • A prevalance of greater than 4% indicates a massive public health problem of chronic otitis media which needs urgent attention in targeted populations.{WHO/CIBA Foundation Workshop. Prevention of hearing impairment from chronic otitis media. WHO/PHD/98.4; 1996)
Deadly Ears

In Australia, some literature reports that Australian Indigenous children experience the highest prevalence of chronic suppurative otitis media (chronic middle ear disease) in the world, with rates of up to 70% in some remote communities.
Coates, H. Current management of OM in Australia – Foreword. Otitis Media 2009: An Update. Med J Aust. 2009; 191: s37.

It is worth noting that across Australia - and indeed across Queensland - the rates and profile of middle ear disease vary greatly. It is not advisable to apply studies to all Aboriginal and /or Torres Strait Islander children.

Nevertheless, studies in some communities across Australia have found Aboriginal and/or Torres Strait Islander children with extremely high rates of middle ear disease and associated conductive hearing loss, and there is evidence that these problems can begin when the children are only several weeks old.

Some examples of this can be found in the following papers: Kong K, and Coates, H. Natural history, definitions, risk factors and burden of otitis media. Otitis Media 2009: An Update. Med J Aust. 2009; 191: s37.
Also: Couzos S, Metcalf S, and Murray R. The systematic review of existing evidence and primary care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander Populations - March, 2001. OATSIH publications: Department of Health and Ageing. (Last accessed on 1st April 2010).
Also: World Health Organization. Chronic suppurative otitis media: burden of illness and management options. Geneva: WHO, 2004.
Available from URL: http://www.who.int/pbd/deafness/activities/hearing_care/otitis_media.pdf

Impacts

There are enhanced risks of:
  • Hearing loss, with the conductive hearing loss potentially progressing to permanent hearing loss;
  • Developmental impacts;
  • Damage to social and emotional wellbeing; and
  • Perceived behavioural difficulties, sometimes because the child doesn’t hear instructions.

In day care, kindy and early school years, there may be a lack of engagement in the class. This might be because either the child is not able to be present or cannot participate. This can lead to poor educational outcomes.

Sometimes, a child might be negatively labelled with learning or behavioural difficulties rather than having a hearing impairment.

By the time the child reaches early adulthood, the negative outcomes can become more significant, and these include:

  • Poor school completion rates;
  • Poor health literacy;
  • Poor lifestyle choices;
  • Conductive hearing loss is worsening to progressing to permanent hearing loss;
  • Poor vocational/job prospects;
  • Anti-social behaviour;
  • Low self esteem; and
  • Socio-economic disadvantage.

A good summary is also available from:

What can you do if you're concerned?

Please take your child to your local health centre and ask for their ears to be checked by a doctor, nurse or health worker. Click here to listen to a parent tell their story.

How health staff check for middle ear disease

There are three common tests, and one or all of these may be used.

Staff use an:

  • otoscope to check the outer ear and ear drum;
  • tympanometer to check the middle ear;
  • audiometer to check hearing and the inner ear.

Ear screening devices

How to prevent ear disease

The best way to prevent children getting ear disease is to have their ears checked every time they see the health worker, nurse or doctor. 

In addition, the following are recommended:

  • keep children clean (wash their hands and faces regularly);
  • ensure children eat healthy foods like fruit and vegetables. If unavailable, use frozen or canned fruit and vegetables;
  • make sure children get all their vaccinations;
  • get children to blow their nose, then wash their hands. Nose blowing opens up the Eustachian tube. This helps get fresh air into the middle ear space;
  • breastfeeding helps babies fight disease, so it is important to do so for as long as possible;
  • avoid smoking around children; and
  • avoid sticking anything in a child’s ears, unless recommended by a health worker, nurse or doctor.

For any additional information, refer to http://www.careforkidsears.health.gov.au/internet/cfke/publishing.nsf/Content/about-otitis-media

Go to Toptop of page



This website may contain images and voice/video recordings of those who have passed away.


Last Updated: 08 January 2016
Last Reviewed: 08 January 2016