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Preventative and medical treatment of ear disease in remote or resource-constrained environments

  • S Brophy-Williams (a1) (a2), K Jarosz (a1) (a2), J Sommer (a1) (a2), A J Leach (a1) and P S Morris (a1) (a2)...

Important ear problems can affect the outer ear, the middle ear and the inner ear. Globally, the greatest burden of disease is due to ear conditions that are associated with otorrhoea and hearing loss.


This study reviewed the literature on the prevention and treatment of common ear conditions that are most relevant to settings with high rates of ear disease and limited resources. The grading of recommendations assessment, development and evaluation (‘GRADE’) approach was utilised to assess interventions.


Accurate diagnosis of ear disease is challenging. Much of the preventable burden of ear disease is associated with otitis media. Nine otitis media interventions for which there is moderate to high certainty of effect were identified. While most interventions only provide modest benefit, the impact of treatment is more substantial in children with acute otitis media with perforation and chronic suppurative otitis media.


Disease prevention through good hygiene practices, breastfeeding, reducing smoke exposure, immunisation and limiting noise exposure is recommended. Children with acute otitis media with perforation, chronic suppurative otitis media, complications of otitis media, and significant hearing loss should be prioritised for medical treatment.

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Corresponding author
Author for correspondence: Professor Peter S Morris, Child Health Division, Menzies School of Health Research, Darwin, NT, Australia E-mail:
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Professor P S Morris takes responsibility for the integrity of the content of the paper

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