Australian Doctor 18th July 2025 | Page 30

18 JULY 2025 ausdoc. com. au being non-invasive, low-cost and

64, 65 relatively safe.

Aboriginal and Torres Strait Islander screening tools

The PLUM( Parent-evaluated Listening and Understanding Measure) and HATS( Hearing and Talking Scale) tools are promising advancements in the early detection and management of hearing and communication issues among Aboriginal and Torres Strait Islander children. 66, 67 Developed collaboratively by the National Acoustic Laboratories, Hearing Australia and Western Sydney University, these tools are designed to help health and early childhood workers screen listening and yarning skills in children

66, 67 younger than six.

By asking parents specific, culturally appropriate questions about their child’ s hearing and communication abilities, PLUM and HATS provide a reliable method to identify children who may need further hearing or speech interventions. This approach is particularly valuable in communities where hearing assessments may not be as accessible. The validation of these tools in urban, regional and remote settings ensures their effectiveness across diverse environments and makes them a noteworthy advance in improving early childhood hearing health and educational outcomes.

WHO World Report on Hearing

The 2021 WHO World Report on Hearing provides a comprehensive overview of the global burden of hearing loss and outlines strategies for integrating ear and hearing care into national health plans. 37 The report emphasises the importance of“ integrated people-centred ear and hearing care”( IPC-EHC) and presents epidemiological and financial data on hearing loss. It highlights cost-effective solutions and proposes key interventions under the H. E. A. R. I. N. G. framework, which includes measures such as Hearing screening, Ear disease prevention, Access to hearing technologies, Rehabilitation services, Improved communication, Noise control and Governance. 37

The report also focuses on the disparities in hearing care services, particularly in low- and middle-income countries and calls for strengthened health systems to address these gaps. Recent updates include the validation of new tools and technologies for hearing screening and the implementation of community-based hearing care programs to improve access and outcomes. 37 Macquarie University in Sydney is the WHO Collaborating HEAR Centre in ear and hearing care.

CASE STUDY

A TWO-year-old Aboriginal girl, Straya, presents to a large regional Community Controlled Health Service with a history of recurrent ear infection. Her mother, who works in that service, knows and trusts the non-Aboriginal GP. Straya has experienced six episodes of AOM with bulging tympanic membranes and / or acute

Figure 8. Attic cholesteatoma.

perforations with discharge in the past year, with three occurring in the past six months. Straya’ s mother is worried as she is not listening and is misbehaving, which is not like her. She only has a few words and never puts two words together. Mum is worried as the kids in day care her age are very talkative. The family are well connected to the local Aboriginal Community Controlled Health Organisation( ACCHO) and feel safe and listened to in this setting. Mum and Straya have had regular health checks and access to health literacy resources and community health promotion days, as well as access to cultural safety in care when unwell.

On examination, Straya has a fever( 38.5 ° C), is irritable and is tugging on her right ear. Otoscopic examination reveals a bulging, erythematous tympanic membrane with purulent

OTITIS MEDIA IN CHILDREN

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Image courtesy Dr N Patel. discharge from a small perforation in the right ear. The left tympanic membrane is pale and opaque and has a type B tympanogram. Her chest is clear, and there is no rash. The GP diagnoses AOM with perforation on the right and OME on the left.

The GP explains the current diagnosis and acknowledges Mum’ s concerns about a possible speech and language delay. Given the perforation, the GP explains the importance of starting antibiotics for this presentation but also addressing the recurrent AOM history. Mum has a good income, and they live in a two-bedroom house with no exposure to environmental smoke. Recognising the family’ s strengths and engagement with their community and the local ACCHO, the GP prescribes amoxicillin 90mg / kg / day in two divided doses for 14 days, books a review in one week and explains that

Mum should bring Straya back sooner if she is not getting better in a couple of days.

Straya is referred for audiological assessment, ENT review and speech pathology to address her hearing difficulties, support her speech and language development and discuss additional options to prevent recurrence.

The family’ s connection to their community and access to culturally safe, holistic care through the ACCHO are key protective factors. Mum’ s education, income, health literacy and knowledge of the system give her better access to high-quality care than many other families in Australia and are protective factors against missed diagnoses and missed complications. The GP acknowledges these strengths while addressing the systemic and structural barriers impacting the family’ s social determinants of health.

At one-week review, Straya’ s symptoms have improved, the discharge has stopped and she is afebrile and nearly back to her normal self. Mum expresses confidence in managing Straya’ s ear health and feels supported by the care team. Audiological assessment confirms mild conductive hearing loss, and follow-up is arranged with the ENT who visits the ACCHO and operates from the local base hospital to consider other management options.

Straya’ s behaviour gradually improves, and within six months, she is talking in short phrases and telling her mum what she is doing in day care.

This case demonstrates the value of leveraging community strengths, culturally safe care and shared decision-making when managing OM. Addressing social determinants, alongside family and community strengths, ensures better health outcomes and reduces long-term impacts of chronic ear disease.