Absent otoacoustic emissions predict otitis media in young Aboriginal children: a birth cohort study in Aboriginal and non-Aboriginal children in an arid zone of Western Australia


Lehmann, Deborah; Weeks, Sharon; Jacoby, Peter; Elsbury, Dimity; Finucane, Janine; Stokes, Annette; Monck, Ruth; Coates, Harvey; Aalberse, J.; Alpers, K.; Arumugaswamy, A.; Beissbarth, J.; Bonney, P.; Bowman, J.; Carter, J.; Carville, K.; Coleman, S.; Cripps, A.; Dorizzi, L.; Dunn, D.; Edwards, E.; Forrest, A.; Foxwell, R.; Gordon, C.; Harrington, B.; Harnett, G.; Jeffries-Stokes, C.; Johnston, J.; de Klerk, N. H.; Kyd, J.; Kyaw-Myint, S. M.; Lannigan, F.; Leach, A. J.; Lewis, T.; McAullay, D.; McIntosh, P.; Meiklejohn, K.; Murphy, D.; Nichols, F.; Pingault, N.; Richmond, P.; Riley, T. V.; Sivwright, K.; Smith, D.; Sorian, S.; Spencer, J.; Stanley, F. J.; Tamwoy, J.; Taylor, A.; Watson, K.; Wood, K.

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Otitis media (OM) is the most common paediatric illness for which antibiotics are prescribed. In Australian Aboriginal children OM is frequently asymptomatic and starts at a younger age, is more common and more likely to result in hearing loss than in non-Aboriginal children. Absent transient evoked otoacoustic emissions (TEOAEs) may predict subsequent risk of OM. 100 Aboriginal and 180 non-Aboriginal children in a semi-arid zone of Western Australia were followed regularly from birth to age 2 years. Tympanometry was conducted at routine field follow-up from age 3 months. Routine clinical examination by an ENT specialist was to be done 3 times and hearing assessment by an audiologist twice. TEOAEs were measured at ages <1 and 1-2 months. Cox proportional hazards model was used to investigate the association between absent TEOAEs and subsequent risk of OM. At routine ENT specialist clinics, OM was detected in 55% of 184 examinations in Aboriginal children and 26% of 392 examinations in non-Aboriginal children; peak prevalence was 72% at age 5-9 months in Aboriginal children and 40% at 10-14 months in non-Aboriginal children. Moderate-severe hearing loss was present in 32% of 47 Aboriginal children and 7% of 120 non-Aboriginal children aged 12 months or more. TEOAE responses were present in 90% (46/51) of Aboriginal children and 99% (120/121) of non-Aboriginal children aged <1 month and in 62% (21/ 34) and 93% (108/116), respectively, in Aboriginal and non-Aboriginal children at age 1-2 months. Aboriginal children who failed TEOAE at age 1-2 months were 2.6 times more likely to develop OM subsequently than those who passed. Overall prevalence of type B tympanograms at field follow-up was 50% (n = 78) in Aboriginal children and 20% (n = 95) in non-Aboriginal children. The burden of middle ear disease is high in all children, but particularly in Aboriginal children, one-third of whom suffer from moderate-severe hearing loss. In view of the frequently silent nature of OM, every opportunity must be taken to screen for OM. Measurement of TEOAEs at age 1-2 months to identify children at risk of developing OM should be evaluated in a routine health service setting.

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BMC Pediatrics, Vol. 8 (Aug 2008), article no. 32




BioMed Central


Copyright © 2008 Lehmann et al; licensee BioMed Central Ltd. This an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The published version is reproduced in accordance with this policy.