Prevention and Treatment

 

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Prevention and Treatment

Prevention - Stop the first infection

There is an urgent need to reduce the risk factors for children developing OM in the early stages of life.  There are a range of strategies that may reduce the overall risk levels – reducing children’s exposure to smoke, facilitating handwashing and other hygiene practices that disrupt the spread of OM pathogens, and encouraging breast feeding.  Critically, overcrowding plays a key role in the spread of OM, so improved housing with adequate infrastructure for handwashing and bathing is needed. There is a strong link between housing and health, and communities need to be supported to maintain healthy homes for healthy kids with healthy ears.

Many aspects of OM’s prevalence, prevention and treatment, remain puzzling for scientists and health practitioners. While there are certainly associations between some practises and the increased risk of OM, such as exposure to smoke, overcrowding, poor nutrition and poor hygiene, it is probably far worse when multiple factors exist, and addressing single issues may not be helpful.  The impacts of health promotion activities on reducing risks and promoting preventative practises, such as smoking cessation, breast feeding and improved nutrition, have not been rigorously evaluated.

Vaccines (pneumococcal conjugate vaccines) are effective but cover only a small proportion of the diversity of pathogens that can cause OM. For example there are 94 known types of pneumococcus. Current vaccines cover 10 to 13 of the most common types. Thus vaccines can only prevent OM episodes caused by these strains. Another disadvantage for Indigenous infants is that OM commences very early, before they are protected by the 3-dose infant vaccine schedule which is completed at 6 months of age. One approach is to protect babies by vaccinating mothers, but studies have shown that maternal vaccination is not effective. Another problem is that there are other OM pathogens for which there is no effective vaccine.  New vaccines are under development and must be evaluated in high risk populations.

Importantly, one of the best strategies for prevention is a skilled and knowledgeable workforce who can respond to the unique pattern of OM in Aboriginal and Torres Strait Islander children (early onset, asymptomatic, persistent and very severe), particularly in remote areas. Where staff turnover is high and the local workforce is over-burdened with issues of chronic disease management, there is a need for innovative strategies to improve the diagnosis and management of OM.

 

Treatment of OM

Detection – Acute OM is often asymptomatic in Indigenous children

In order to reduce the progression and severity of OM, early detection and appropriate treatment is needed. For most children, acute otitis media (AOM) is associated with pain, fever, irritability and ear pulling. However as many Indigenous children with AOM are asymptomatic, health care providers need to examine every ear of every child at every opportunity. This requires clinics to have the proper equipment to examine children’s ears and for medical staff to be appropriately trained to diagnose OM and develop an appropriate treatment plan. A bulging eardrum is the best sign of AOM. The most common form of OM is otitis media with effusion (fluid in the middle ear that can cause hearing loss, but there is no bulging ear drum). An immobile ear drum is the best sign of OME.

Treatment of infection – longer stronger antibiotics are usually needed

There are several different treatment approaches for treating OM, however more research is needed to develop more effective and innovative prevention strategies and treatment therapies. Antibiotics can cure a proportion of acute infections, thereby preventing some eardrum perforations, but longer courses and higher doses are needed in Indigenous children compared to non-Indigenous children. Widespread use of these antibiotics can increase the risk that the bacteria become resistant to antibiotics, which is a significant public health concern.  Long term topical therapies such as antibiotic ear drops for “runny ears” and strategies to enhance case management of children with CSOM have had no substantial impact on clinical cure. 

 

Treatment – surgery

There are also surgical procedures, such as the insertion of grommets for children with OME and hearing loss, which can be effective but can also have adverse outcomes. Such surgical procedures have not been well evaluated in Indigenous children. 

 

Treatment – hearing and language assistance

 

Children with OM and hearing loss require assistance to gain attention and provide environments that encourage listening and language stimulation.  Parents, families, teachers and communities need better information about how to identify a child with possible hearing loss, and assist in overcoming that loss.

The CRE_ICHEAR will work with the community to raise awareness of OM and how hearing loss impacts on their children’s ability to understand what’s going on around them, to learn language and be ready for school and do well at school.  Parents need to understand the need for regular ear assessments and how to communicate well with their hearing impaired children. 

For researchers

Otitis Media (OM), sometimes known as glue ear or runny ears…

For health practitioners

Otitis Media (OM), sometimes known as glue ear or runny ears…

For families and communities

Many Indigenous children, and almost all Indigenous children living in remote communities...