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Otitis media in Indigenous Australian children: review of epidemiology and risk factors

  • Jake Jervis-Bardy (a1), L Sanchez (a1) and A S Carney (a1)

Otitis media represents a major health concern in Australian Indigenous children (‘Indigenous children’), which has persisted, despite public health measures, for over 30 years.


Global searches were performed to retrieve peer-reviewed and ‘grey’ literature investigating the epidemiology of and risk factors for otitis media in Indigenous children, published between 1985 and 2012.


In Indigenous children, the prevalence of otitis media subtypes is 7.1–12.8 per cent for acute otitis media, 10.5–30.3 per cent for active chronic otitis media and 31–50 per cent for tympanic membrane perforation. The initial onset of otitis media in Indigenous children occurs earlier and persists for longer after the first year of life, compared with non-Indigenous children. Indigenous children are colonised by otopathogens more frequently, at younger ages and with a higher bacterial load. Poor community and domestic infrastructure, overcrowding and exposure to tobacco smoke increase the risk of otitis media in Indigenous children; however, the availability of swimming pools plays no role in the prevention or management of otitis media.


Despite awareness of the epidemiological burden of otitis media and its risk factors in Indigenous children, studies undertaken since 1985 demonstrate that otitis media remains a significant public health concern in this population.

Corresponding author
Address for correspondence: Prof A S Carney, Flinders ENT, Department of Surgery, Room 3D204, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia Fax: +61 8 8204 3987 E-mail:
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11J Boswell , T Nienhuys . Onset of otitis media in the first eight weeks of life in Aboriginal and non-Aboriginal Australian infants. Ann Otol Rhinol Laryngol 1995;104:542–9

13J Boswell . Presentation of early otitis media in ‘Top End' Aboriginal infants. Aust N Z J Public Health 1997;21:100–2

15D Lehmann , A Arumugaswamy , D Elsbury , J Finucane , A Stokes , R Monck The Kalgoorlie Otitis Media Research Project: rationale, methods, population characteristics and ethical considerations. Paediatr Perinat Epidemiol 2008;22:6071

17GA Mackenzie , JR Carapetis , AJ Leach , PS Morris . Pneumococcal vaccination and otitis media in Australian Aboriginal infants: comparison of two birth cohorts before and after introduction of vaccination. BMC Pediatr 2009;9:14

22DS Watson , M Clapin . Ear health of aboriginal primary school children in the Eastern Goldfields Region of Western Australia. Aust J Public Health 1992;16:2630

24P Morris , A Leach , P Silberberg , G Mellon , C Wilson , E Hamilton Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross-sectional survey. BMC Pediatr 2005;5:27

29LC Johnston , HM Feldman , JL Paradise , BS Bernard , DK Colborn , ML Casselbrant Tympanic membrane abnormalities and hearing levels at the ages of 5 and 6 years in relation to persistent otitis media and tympanostomy tube insertion in the first 3 years of life: a prospective study incorporating a randomized clinical trial. Pediatrics 2004;114:5867

35H Gunasekera , S Knox , P Morris , H Britt , P McIntyre , JC Craig . The spectrum and management of otitis media in Australian indigenous and nonindigenous children: a national study. Pediatr Infect Dis J 2007;26:689–92

38J Engel , L Anteunis , A Volovics , J Hendriks , E Marres . Prevalence rates of otitis media with effusion from 0 to 2 years of age: healthy-born versus high-risk-born infants. Int J Pediatr Otorhinolaryngol 1999;47:243–51

39K Tomonaga , Y Kurono , G Mogi . The role of nasal allergy in otitis media with effusion: a clinical study. Acta Otolaryngol (Stockh) 1988;105:41–7

40K Prellner , O Kalm , G Harsten , J Heldrup , VA Oxelius . Pneumococcal serum antibody concentrations during the first three years of life: a study of otitis-prone and non-otitis-prone children. Int J Pediatr Otorhinolaryngol 1989;17:267–79

41KJ Kvaerner , K Tambs , J Harris , P Magnus . Distribution and heritability of recurrent ear infections. Ann Otol Rhinol Laryngol 1997;106:624–32

43AL Kadhim , K Spilsbury , JB Semmens , HL Coates , FJ Lannigan . Adenoidectomy for middle ear effusion: a study of 50,000 children over 24 years. Laryngoscope 2007;117:427–33

45J Pukander , J Luotonen , M Sipilau , M Timonen , P Karma . Incidence of acute otitis media. Acta Otolaryngol (Stockh) 1982;93:447–53

46JL Paradise , HE Rockette , DK Colborn , BS Bernard , CG Smith , M Kurs-Lasky Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. Pediatrics 1997;99:318–33

47M Uhari , K Mäntysaari , M Niemelä . Meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis 1996;22:1079–83

49JO Klein . Otitis media. Clin Infect Dis 1994;19:823–32

50AJ Leach , JB Boswell , V Asche , TG Nienhuys , JD Mathews . Bacterial colonisation of the nasopharynx predicts very early onset and persistence of otitis media in Australian aboriginal infants. Pediatr Infect Dis J 1994;13:983–9

52H Faden , L Duffy , R Wasielewski , J Wolf , D Krystofik , Y Tung . Relationship between nasopharyngeal colonisation and the development of otitis media in children. J Infect Dis 1997;175:1440–5

53H Smith-Vaughan , R Byun , M Nadkarni , NA Jacques , N Hunter , S Halpin Measuring nasal bacterial load and its association with otitis media. BMC Ear, Nose Throat Disord 2006;6:10

55J Pukander , J Luotonen , M Timonen , P Karma . Risk factors affecting the occurrence of acute otitis media among 2-3-year-old urban children. Acta Otolaryngol (Stockh) 1985;100:260–5

56D Fliss , I Shoham , A Leiberman , R Dagan . Chronic suppurative otitis media without cholesteatoma in children in southern Israel: incidence and risk factors. Pediatr Infect Dis J 1991;10:895–9

58R Bailie , M Stevens , E McDonald , D Brewster , S Guthridge . Exploring cross-sectional associations between common childhood illness, housing and social conditions in remote Australian Aboriginal communities. BMC Public Health 2010;10:147

63C Sabella . Management of otorrhea in infants and children. Pediatr Infect Dis J 2000;19:1007–8

65D Lee , A Youk , NA Goldstein . A meta-analysis of swimming and water precautions. Laryngoscope 2009;109:536–40

66R Carbonell , V Ruíz-García . Ventilation tubes after surgery for otitis media with effusion or acute otitis media and swimming. Systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2002;66:281–9

67W Nystad , F Njå , P Magnus , P Nafstad . Baby swimming increases the risk of recurrent respiratory tract infections and otitis media. Acta Paediatr 2003;92:905–9

69D Lehmann , MT Tennant , DT Silva , D McAullay , F Lannigan , H Coates Benefits of swimming pools in two remote Aboriginal communities in Western Australia: intervention study. BMJ 2003;327:415–19

71AT Stephen , AJ Leach , PS Morris . Impact of swimming on chronic suppurative otitis media in Aboriginal children: a randomised controlled trial. Med J Aust 2013;199:51–5

73SW Abrahams , MH Labbok . Breastfeeding and otitis media: a review of recent evidence. Curr Allergy Asthma Rep 2011;11:508–12

75ÖC Ilicali , N Keleş , K Deger , ÖF Sàgun , Y Güldíken . Evaluation of the effect of passive smoking on otitis media in children by an objective method: urinary cotinine analysis. Laryngoscope 2009;111:163–7

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
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