Aims:
- To determine the efficacy of topical and oral treatments for resolution of discharging ears among Aboriginal children with chronic suppurative otitis media (CSOM).
Objectives:
- To compare the efficacy of the following strategies reduce the proportion of children with discharging perforations after 16 weeks of treatment:
- twice daily antiseptic ear wash (>= 20mls povidine-iodine 0.5% solution syringed into the ear canal) prior to standard topical antibiotic treatment (compared to standard topical antibiotic treatment alone)
- twice daily oral antibiotic treatment (cotrimoxazole 4mg/kg per dose of trimethoprim component) given in addition to standard topical antibiotic treatment (compared to placebo).
Summary:
Otitis media is an important health problem affecting the hearing of up to 80% of remote Northern Territory (NT) Aboriginal children. Many have Chronic Suppurative Otitis Media (CSOM). Treatment guidelines recommend twice daily ear cleaning and ciprofloxacin drops with weekly clinic review and referral. In clinical trials, efficacy for this strategy is around 30%. Thus, hearing loss persists with long term implications for educational, social and behavioural problems.
West Australia's practice is to use dilute Betadine® ear washes. A Dutch study suggests that oral trimethoprim-sulfamethoxazole (cotrimoxazole) prolongs ear dryness in CSOM. Our microbiological work shows ongoing non-typable Haemophilus influenzae (NTHi) infection of the middle ear suggesting a role of nasopharyngeal (NP) colonisation and need for systemic antibiotics.
In this study Aboriginal children >6 months and <17 years of age will be screened for CSOM, aiming for 280 randomisations. Each consenting child will also receive usual care. Allocation will be stratified by community and age group. Ear and NP swabs will be taken. The study will use molecular typing to distinguish new NTHi infection from persistence (treatment failure). The primary outcome will be failure after a four month intervention period. Secondary outcomes will include hearing, adherence, microbiology, complications and side effects.
Implications for policy and practice:
This study is an important development for the assessment of interventions in Aboriginal health. It combines the recent experience of intensive studies involving small numbers of children with a practical approach to more effective medical treatments for an important and common health problem.
The results of the trial will become the best available evidence to guide the medical management of CSOM in high-risk children. It will be an important contribution to the medical literature and the results will have implications for all disadvantaged populations where adverse outcomes are common. This project will also provide improved training and education materials for a large number of NT health staff. Ongoing education and support is essential in the transition toward more effective prevention and management of chronic suppurative otitis media in Aboriginal children.
Chief investigator:
Project manager:
Contact information:
Project dates:
The study will commence in 2014 and conclude in 2017.
Funders:
- National Health and Medical Research Council (NHMRC)
Collaborators:
- Northern Territory Department of Health.
-
New interactive guidelines for healthy ears
I-CHEAR director and Menzies School of Health Research senior principal research fellow, Professor Amanda Leach AM said that the updated guidelines are needed to improve delivery and access to quality ear health care across Australia.
-
Ear disease in Aboriginal and Torres Strait Islander children
In remote communities across the Northern Territory (NT), only one in 10 Aboriginal children younger than three years have healthy ears, a new report in the Medical Journal of Australia (MJA) has found.
-
Aboriginal ear surgeon honoured with Menzies Medallion
Australia’s first Aboriginal surgeon, the highly acclaimed ear, nose and throat surgeon, Associate Professor Kelvin Kong has been awarded the prestigious Menzies Medallion.
-
First Nations Telegraph | Tiwi ears in Tiwi hands
Newly graduated ear health facilitators will provide local knowledge and expertise when checking the ears and hearing of children in their community.
-
Katherine recruits wanted to help with chronic ear health problems
The community-based solution to the life-long problem of hearing loss among almost all Aboriginal children is also being rolled out in Katherine later this year.
-
Hearing loss impacts school attendance among Australia's aboriginal children
The study was led by Dr. Jiunn-Yih Su with the Centre for Child Development and Education, Menzies School of Health Research, and the Charles Darwin University.
-
Hearing loss linked to poor school attendance for Aboriginal and Torres Strait Islander children
The first study investigating hearing impairment on school attendance for Aboriginal and Torres Strait Islander children has been released.
-
It’s possible to take a break from science and make a comeback
Overcoming gender bias and structural barriers is a hard task, on top of the research itself. Someone who has achieved both is Prof Amanda Leach.
-
Severe specialist shortage leaves Aboriginal children at risk of hearing loss
Menzies School of Health Research professor Amanda Leach has been working in hearing health in the NT and said Aboriginal communities were becoming frustrated with service delivery.
-
'I cried from happiness': Indigenous toddler hears her first words
The government has provided funding to the Menzies School of Health Research's Hearing for Learning Initiative, a five-year $7.9m program in which health project officers help Aboriginal children with hearing problems.
-
Government funded health programs for NT's deaf children
The government has provided funding to the Menzies School of Health Research's Hearing for Learning Initiative, a five-year $7.9m program in which health project officers help Aboriginal children with hearing problems, NT Health Minister Natasha Fyles said.
-
Media Release | Improved ear and hearing planned for children in Maningrida
The Mala’la Health Service Aboriginal Corporation has welcomed Maningrida‘s participation in the Menzies School of Health Research (Menzies) Hearing for Learning Initiative.
-
Indigenous issues top to-do list as super-rich urged to dig deep
Supports for a five-year project at the Menzies School of Health Research to address hearing problems among indigenous people in the Northern Territory.
-
NT News | Big Night for Territorians
Report on Professor Amanda Leach and other NT finalists in the 2019 Telstra Businesswomen's Awards .
-
Indigenous health in limelight at Telstra Business Women’s Awards
Professor Amanda Leach is a Principal Senior Research Fellow at the Menzies School of Health Research, the institute leading the way in Aboriginal and Torres Strait Islander medical research.
-
COAG Health Council | Communiqué 8 March 2019
The Federal, state and territory Health Ministers met in Adelaide at the COAG Health Council to discuss a range of national health issues.
-
Menzies researchers’ finalists in the 2019 Telstra Business Women’s Awards
Two researchers from Menzies School of Health Research (Menzies) have been named finalists in the 2019 Telstra Business Women’s Awards.
-
NT News | Our children's hearing crisis
To address chronic hearing problems in the NT's most vulnerable children a $7.9 million community-led program will be rolled out.
-
ABC TV Back Roads program features Christine Wigger
Christine Wigger has been researching otitis media in the Tiwi Islands over 15 years.
-
Australian Doctor - otitis media clinical trial
Otitis Media - a clinical trial where Indigenous infants will receive an extra dose of pneumococcal vaccine to try and cut down the rates of incidence.
-
New Vaccine could help reduce Chronic ear disease.
Menzies School of Health researchers are hoping to reduce rates of a chronic ear disease called Otis Media, in remote indigenous communities. (Image source: creative commons)
-
Extra vaccines may reduce 'unacceptable rates' of chronic ear disease in Indigenous children
The Menzies School of Health Research is conducting a clinical trial in remote communities in the Northern Territory and Western Australia, and hope the results will change the public health approach and give more help to families.