COMHeLP

Best Practice for Aboriginal and

Torres Strait Islander Ear and

Hearing Health

The Ear Ring

“He’s like that because I married my cousin. It’s Tiwi way.”

Father of a Child with Global Developmental Delay and Ear Disease, Feb 2013

“We been growling him and hitting him cos we think he bein’ naughty…and

he couldn’t listen us.”Mother of a Child with Bilateral OME and Moderate Hearing Loss, Oct 2013

HOW DO WE IMPROVE

OUTCOMES?

COMHeLP

Increased Role for Audiology in

Primary Health

• Ear and Hearing Health Education for

Professionals

• Health Promotion and Literacy

Development to Individuals and Families

• Improved support to surveillance programs

• Extended audiological scopes of practice

Ear & Hearing Health Education to

Health and Education staff

“We didn’t refer them to the

Health Centre because they

don’t have ear disease. They

just don’t hear very well.”Special Needs Teacher, Remote Community, Central Australia, Nov 2012

Ear Health vs Hearing

• Foreign Body

• Otitis Media (OM)

– ETD

– OME

– AOMwoP

– Dry Perforation

• Otitis Externa

• Otitis Media

– AOMwiP

– CSOM

• Difficulty following

conversation in noise

• Difficulty understanding

over distance

• Requires visual cues for

understanding

• Poor attention for

auditory stimuli

• Speech language delay

• Learning challenges

A

s

y

m

pt

o

m

at

ic

S

y

m

pt

o

m

at

ic

Ear & Hearing Health Education to

Health and Education staff

• Auditory development

• Impacts of ear disease

• Signs and symptoms of ear/hearing problems

• Simple checks for ear health

• Importance of early intervention for ear/hearing problems

• Referral pathways

Ear Health Promotion and Health

Literacy Development

• To individuals and families

• Supports client decision-making

• Involves

- Identifying current health literacy level (including the

client’s personal capacity to take in and act on new

information)

- Recognising cultural and personal concepts of health

- Relating info back to the client’s own environment and

family priorities to ensure relevance

Screening vs Surveillance

• Screening

– Takes a snapshot of the

ear/hearing health at one

point in time

– Is often an isolated incident

– No evidence that screening

improves outcomes for

young children with OM

(Hopkins & Morris, 2009)

– Management of

ear/hearing is usually

based on single set of

results

• Surveillance

– Systematic gathering of ear

and hearing health of an

individual/group over time

– Screening is incorporated

in accumulated data

– Management of

ear/hearing is determined

on both individual

screening and accumulated

data

Benefits of Surveillance

Can build ear health surveillance into regular

health checks (well baby, immunisation

visits, GP visits)

Can identify children with ear health/hearing

concerns earlier than formal screening

programs => early intervention

Provides more opportunities for ear

health/hearing literacy development with

parents and carers

Interdisciplinary Collaboration• Community Authorities (Council, Elders, etc.)

– to support shared outcomes of community-based ear health/hearing programs

– to provide community/cultural knowledge

• Child Health and Early Childhood Workers – to support early ear/hearing problem identification and

management

• Education staff and Allied Health– to support remediation of impacts of hearing loss

• Health Educators/Promoters and Interpreters– to develop health literacy in client populations

• ENT Specialists – to medically manage advanced or persistent ear disease

• Researchers – to develop and evaluate effective treatment and management

methods

Extended Audiological Scopes of

Practice

Ear Canal Management

• tissue spears for discharge (anyone)

• wax removal using loupes or syringing

Diagnosis of Otitis Media Conditions

COMHeLP• Overview of OM in the A&TSI population

Includes extended audiological scopes of practice

• Section 1: Practical Considerations

Includes ear and hearing health education for professionals

• Section 2: Preventative Strategies and messages to Improve

Health Literacy

Includes health Promotion and Literacy Development to

Individuals and Families

• Section 3: Primary Surveillance, Management and Referral

Includes improved support to surveillance programs

• Section 4: Identification: Diagnostic Audiological Assessment

Includes extended audiological scopes of practice

• Section 5: Management and Rehabilitation of Hearing Loss

• Section 6: Research, Evaluation and Quality Improvement

Ongoing Challenges

• Staff turnover, especially in rural/remote =>

constant need to establish relationships and

train basic information over again

• Documentation

– access to records across different systems

– quality of documentation, especially client education

– tracking for surveillance through individual client

records

• Fatigue and frustration for families managing

Chronic OM

Questions