The spectrum and management of otitis media in Australian indigenous and nonindigenous children: a national study

Pediatr Infect Dis J. 2007 Aug;26(8):689-92. doi: 10.1097/INF.0b013e3180621177.

Abstract

Background: Indigenous children have the highest reported prevalence and severity of otitis media in the world, but whether their clinical management varies accordingly is unknown.

Methods: Using a representative Australia-wide cluster survey of consecutive primary healthcare consultations, we compared practitioners' investigation, treatment, and referral practices for otitis media in indigenous and nonindigenous children (0-18 years), after adjusting for clustering.

Results: Over 8 years (1998-2006), 7991 practitioners managed 141,693 problems during 119,503 consultations with children, including 2856 (2%) with indigenous children. Ear problems were the fourth most common problems managed overall, with otitis media seen more commonly in indigenous than in nonindigenous children (10% versus 7% consultations, P < 0.001). Indigenous children were significantly more likely to have severe otitis media (chronic and/or suppurative and/or perforation, 8% versus 2%, P < 0.001); discharging ears (4% versus 0.1%, P < 0.001); ear swabs [4%, 95% confidence interval (CI): 2%-6% versus 0.8%, 95% CI: 0.6%-0.9%]; and topical eardrops administered (11%, 95% CI: 7%-15% versus 5%, 95% CI: 4%-5%); but not more likely to receive oral antibiotics (72% versus 76%); have ear syringing (1% versus 0.2%); be referred to an otolaryngologist (6% versus 3%) or audiologist (2% versus 1%); all P > 0.05.

Conclusions: In the Australian primary healthcare setting, indigenous children are 5 times more likely to be diagnosed with severe otitis media than nonindigenous children, but reported management is not substantially different, which is inconsistent with established national guidelines. This spectrum-management discordance may contribute to continued worse outcomes for indigenous children with otitis media.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Australia
  • Child
  • Child, Preschool
  • Continental Population Groups*
  • Female
  • Health Surveys
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Otitis Media / epidemiology*
  • Otitis Media / therapy*
  • Otitis Media with Effusion / epidemiology
  • Prevalence
  • Referral and Consultation / statistics & numerical data

Substances

  • Anti-Bacterial Agents