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Otitis media – a multi-factorial disease requiring a multi-faceted approach

Dr Ruth Thornton. Otitis media – a multi-factorial disease requiring a multi-faceted approach. A/Prof Amanda J Leach. Conceptual framework to study causal pathways to Otitis Media (Lehmann et al.). Colonisation of Australia. Marginalisation. Psychosocial problems. Fixed settlements.

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Otitis media – a multi-factorial disease requiring a multi-faceted approach

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  1. Dr Ruth Thornton Otitis media – a multi-factorial disease requiring a multi-faceted approach A/Prof Amanda J Leach OMOZ_2012

  2. Conceptual framework to study causal pathways to Otitis Media (Lehmann et al.) Colonisation of Australia Marginalisation Psychosocial problems Fixed settlements Maternal age Education Housing Employment Single parent Pacifier Seasons Crowding Siblings Daycare Lack of water Smoking Poor nutrition Not Breastfed Coughers High rates of transmission Impaired immunity (young age, suppression, tolerance) Poor hygiene Viruses Early age NP colonisation Bacterial carriage, Prolonged, Multiple OTITIS MEDIA Family history OM or allergy Genetics Educational & social disadvantage Hearing loss Parental smoking Male sex

  3. Conceptual framework to study causal pathways to Otitis Media (Lehmann et al.) Colonisation of Australia Marginalisation Psychosocial problems Fixed settlements Maternal age Education Housing Employment Single parent Pacifier Seasons Siblings Daycare Lack of water Poor nutrition Not Breastfed Crowding Smoking Coughers High rates of transmission Impaired immunity (young age, suppression, tolerance) Poor hygiene Viruses Early age NP colonisation Bacterial carriage, Prolonged, Multiple OTITIS MEDIA Family history OM or allergy Genetics Educational & social disadvantage Hearing loss Parental smoking Male sex

  4. 8 ALGORITHMS OMOZ_2012

  5. Spectrum of otitis media : Otitis media with effusion, OME to CSOM “Otitis media with confusion …?” Professor Ron Dagan, Professor of Pediatrics and Infectious Diseases at the Ben-Gurion University of the Negev, and Director of the Pediatric Infectious Disease Unit at the Soroka University Medical Center, Beer-Sheva, Israel OMOZ_2012

  6. National Trachoma Eye Health Program Over three years, the NTEHP teams covered more than 84,000 kilometres by road and more by air and sea. More than 465 communities were visited and 100,000 people screened, of whom 62,000 were Indigenous Australians. Approximately 27,000 people were treated for trachoma and more than 1,000 operations were performed. ….almost 50% Indigenous population had trachoma. In some regions of the NT and WA, the prevalence was as high as 80%. • At the same time, the NTEHP teams found • 11% of 60,273 Aboriginals had OM • 29% had eardrum scaring • ~18% children < 4 years of age had chronic suppurative otitis media Ear disease in rural Australia. Moran et al. MJA 1979. OMOZ_2012

  7. Med J Aust supplement on Otitis media 2009 MJASUPPLEMENT 2 NOVEMBER 2009 VOLUME 191 NUMBER 9 Otitis media 2009: an update • Current management of otitis media in Australia — foreword Harvey L C Coates — Med J Aust 2009; 191 (9): S37. • Natural history, definitions, risk factors and burden of otitis media Kelvin Kong and Harvey L C Coates — Med J Aust 2009; 191 (9): S39-S43.  • Otitis media: viruses, bacteria, biofilms and vaccines Helen M Massa, Allan W Cripps and Deborah Lehmann — Med J Aust 2009; 191 (9): S44-S49.  • Theories of otitis media pathogenesis, with a focus on Indigenous children Selma P Wiertsema and Amanda J Leach — Med J Aust 2009; 191 (9): S50-S54.  • Primary care management of otitis media among Australian children Hasantha Gunasekera, Tony E O’Connor, Shyan Vijayasekaran and Christopher B Del Mar — Med J Aust 2009; 191 (9): S55-S59.  • Complications of otitis media in Indigenous and non-Indigenous children Tony E O’Connor, Christopher F Perry and Francis J Lannigan — Med J Aust 2009; 191 (9): S60-S64.  • Surgery for otitis media among Indigenous Australians Stephen J O’Leary and Ross D Triolo — Med J Aust 2009; 191 (9): S65-S68.  • The impact of otitis media on cognitive and educational outcomes Corinne J Williams and Ann M Jacobs — Med J Aust 2009; 191 (9): S69-S72.  • New horizons: otitis media research in Australia Peter S Morris, Peter Richmond, Deborah Lehmann, Amanda J Leach, Hasantha Gunasekera and Harvey L C Coates — Med J Aust 2009; 191 (9): S73-S77. 2000 to April 2009

  8. PubMed search “Otitis AND Australia” 320 hits. 189 relevant. 32 free full text. 40 reviews (8 Cochrane). 1970s • Otitis media and hearing loss in a small aboriginal community. Clements. MJA 1968. • Chronic ear disease in aborigines – a research programme. Beaumont. J Otolaryngol Soc Aust 1972. • Challenging aspects of ENT disease among aboriginal children. Willis. J Otolaryngol Soc Aust 1972. • A microbiologist looks at aboriginal health. Doherty. MJA 1974. • Aboriginal health in Mornington Island, 1971. Bolin et al. MJA 1975. • Factors leading to chronic ear disease. Canty et al. MJA 1975. “…aboriginal …” • Influence of nutrition and social conditions on school performance of aboriginal children. Dugdale. MJA 1975 • Otitis media and linguistic incompetence. Lewis Arch Otolaryngol 1976. “..aboriginal..” • Serotypes of pneumococci in pneumonia, meningitis and other.. Hansman D. ANZJMed 1977. • The natural history of chronic middle ear disease in Australian Aboriginals: a cross-sectional study. Dugdale etal. MJA 1978. • Pneumococcal disease and it’s prevention --- a review. Douglas Riley ANZJMed 1979. “…aborigines.. otitis media ..” • Ear disease in rural Australia. Moran et al. MJA 1979. “Aboriginal and non-Aboriginal ..” • ……

  9. PubMed search “Otitis AND Australia” 1980s • Successful assault on ear disease: …intensive daily treatment by nurses and health workers. Peever & ward. MJA 1980 “…43% Aboriginal and 7% white children..” • Respiratory disease among Aborigines in the Pilbara. Torzillo et al. Int J Epidemiol 1983. • An environmental and demographic analysis of otitis media in ..aborigines. Hudson & Rocket 1984. • Microbiology of chronic OME .. Aboriginal: Chlamydia. Dawson et al. Aust J Exp Biol Med Sci. 1985. • OM in the Australian Aboriginal. Willis Am J otol 1985. • Aboriginal child health. Stuart. Aust Fam Physician 1985. 1990s • Causes of CSOM in ..aboriginal ..infants. McConnel et al. 1991 1993 – first studies not to include aboriginal • Short term efficacy of TTs ..OM in Down Syndrome. • Other surgery - tonsillectomy, grommets, cochlear, mastoiditis • Pneumococcal epidemiology - • 1994 • Bacterial colonisation ..aboriginal infants. Leach et al. PIDJ

  10. Australian research into otitis media includes: • studies of animal models assessing potential vaccine candidates and pathogen interactions; • microbiological assessment of specimens from the nasopharynx, middle ear, and ear discharge; new virus & bacteria (human metapneumovirus and Alloiococcus Otitidis) • mathematical modelling of otitis media pathogen interactions; • prevalence surveys; • epidemiological studies of risk factors; • research into features of mastoiditis and cholesteatoma; • reported management of otitis media; • clinical assessment of video-otoscopy; • the effect of swimming pools on otitis media; • measurement of speech comprehension in children with a history of otitis media; • the impact of CSOM on sense of smell; • the effect of fruit consumption; • the effects of surgery, including insertion of ventilation tubes, adenoidectomy, and myringoplasty; • the effects of antibiotic therapy; and • the impact of the newly introduced 7-valent conjugate pneumococcal vaccine. Ear health (EarInfoNet) Morris et al. 2009. MJA.

  11. ……………It’s everywhere Vaccines, antibiotics, hygiene, guidelines, trials, pneumococcology Ear health (EarInfoNet) Epi Speech RCT: topical antibiotics Fruit Swimming pools Viruses & bacteria KalOM cohorts. Risk factors. Smoke. Crowding Cochrane Systematic reviews Animal models: polymicrobial Biofilm Immunology. Genetics Smell Surgery Molecular biology teleotoscopy OMOZ_2012

  12. OMOZ_2012

  13. The OMOZ PROGRAM over 3 days

  14. DAY 1Session 1: 11am – 1pm Bacterial infections and their impact on otitis media development, treatment and outcomes Invited speaker & Chair: Professor Janelle Kyd OMOZ_2012

  15. DAY 1: Bacterial infections and their impact on otitis media development, treatment and outcomes. • What’s new? • Using the laboratory to mimic how bacteria cause otitis media in children. • New discoveries – Ao & Hh. • New ways to measure impact of antibiotics & vaccines. • Nose - Ear – Lung: are the bacteria connected? • When the ear drum perforates – a new world of bacteria discovered. • How will I use this new information? OMOZ_2012

  16. DAY 1Session 2: 2-3.20pm Current, new, and future vaccines and other interventions: how are these likely to impact on otitis media? Invited Speaker & Chair: Professor Peter Richmond. OMOZ_2012

  17. DAY 1: Current, new, and future vaccines and other interventions: how are these likely to impact on otitis media? • What’s new? • Any change in ear disease for Indigenous children? • Laboratory studies of probiotic therapy • Child antibody response to OM • Monitoring change in pneumococcal serotypes • How will I use this new information? OMOZ_2012

  18. DAY 1Session 3: 3.50 -5.20pm Immune responses to otitis media pathogens and disease outcome, and genetic predisposition to otitis media Invited speaker and Chair: Professor Allan Cripps. OMOZ_2012

  19. DAY 1 : Immune responses to otitis media pathogens and disease outcome, and genetic predisposition to otitis media • What’s new? • How the infant immune system responds to bacteria in the nasopharynx. • Studying otopathogens in mice • Human genetics and OM • How will I use this new information? OMOZ_2012

  20. DAY 2Session 1: 9-10.20am Clinical trials in otitis media research – The what, where, why and how of trials happening and what does this mean for future treatments Invited speaker and Chair – Associate Professor Peter Morris OMOZ_2012

  21. DAY 2: Clinical trials in otitis media research – The what, where, why and how ..& … what does this mean for future treatments • What’s new? • Swimming • Vaccines in combination • Tympanic membrane engineering • Coming unstuck – dissolving glue ear • How will I use this new information? OMOZ_2012

  22. DAY 2Session 2: 10.50am -12.15pm Surveillance and epidemiology of otitis media. Prevalence, risk factors, treatment and prevention Invited speakers and Chairs – Associate Professor Deborah Lehmann Associate Professor Peter Morris OMOZ_2012

  23. DAY 2: Surveillance and epidemiology of otitis media. Prevalence, risk factors, treatment and prevention • What’s new? • Household crowding and bacterial infections • Risk factors and health service use • OM in remote Queensland • Ear and hearing health workforce project • How will I use this new information? OMOZ_2012

  24. DAY 2Session 3: 1.30-3.10pm Research transference into health services – comprehensive primary health care service delivery and initiatives such as community ear and hearing health promotion campaigns, equipment training schemes, partnerships with ear health specialists OMOZ_2012

  25. DAY 2: Research transfer • What’s new? • Improved ear health services for Indigenous Australians • Manual for Audiological practice • Goldfields of Western Australian – health promotion and primary health care • EarInfoNet • Mobile ear health program data in Western Australia • How will I use this new information? OMOZ_2012

  26. DAY 2Session 4: 3.40-4.45pm Evidence-based clinical practice – feedback from current clinical programs, new otitis media guidelines and training programs for Aboriginal Health Workers, primary health care workers and other associated Aboriginal health workforce professionals Invited speaker and Chair – Harvey Coates OMOZ_2012

  27. DAY 2: Evidence-based clinical practice - feedback • What’s new? • Integrated service delivery model in the Northern Territory • Role of clinical follow-up. • Parents attitudes. • How will I use this new information? OMOZ_2012

  28. DAY 3Session 1: 9.00 – 10.40am Social and educational determinants and impacts of otitis media on families through the early, school and adult years Chair: Kathy Currie OMOZ_2012

  29. DAY 3: Life course impacts of OM • What’s new? • Wellbeing • Educational needs • Australian Hearing’s role in breaking cycle • Behavioural indicators in Indigenous children • National relay service • How will I use this new information? OMOZ_2012

  30. DAY 3Session 2: 11.10-12.35pm How do we go about improving hearing health for all children? Chair: Samantha Harkus OMOZ_2012

  31. DAY 3:Improving hearing health for all children? • What’s new? • Victorian strategy • Fighting disease with fruit • Urban GPs experience • Managing hearing information • Resource development in the community • How will I use this new information? OMOZ_2012

  32. DAY 3PANEL DISCUSSION Setting priorities for research & advocacy Plans/bids for OMOZ 2014. OMOZ_2012

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