Ear Disease in the NT a complex and persistent infection

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Ear Disease in the NT- a complex and persistent
infection
Peter S Morris and Amanda J Leach For the Child
Health Division of Menzies School of Health
Research, Darwin, Australia.
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Acknowledgments
All the families who have participated in the
Menzies otitis media studies over the past 15
years.
NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL
(NHMRC) THE TIWI HEALTH BOARD Tiwi Island Local
Government and their Community Member Board The
Xavier Community Education Centre Murrupurttiyanuw
u Catholic School Jirnani Child Care
Centre Julanimawu Health Clinic Milikapiti
Health Clinic Pirlangimpi Health Clinic
DARWIN STAFF Mark Bazeley Jemima Beissbarth Edna
Gadil Kim Hare Brooke Harrington Bev
Hayhurst Elizabeth Hamilton Amanda Leach
Grace Perez Tania Shelby-James Peter
Silberberg Heidi Smith-Vaughan Liz Stubbs Cate
Wilson Yvonne Wood Al Yonovitz Leslie Yonovitz
Seija Leach Robyn Liddle Christine Lienert John
Mathews Melita McKinnon Gabby Mellon Peter
Morris Michelle Patterson
TIWI STAFF Boniface Alimankinni Gilbert
Alimankinni Agatina Black Sylvester
Black Jennnifer Black Sacha Cubillo Lynette de
Santis Ainsley Kerinauia Carla Kerinauia
Elsie Kerinauia Rhonda Kerinauia Colin
McPherson Dana Minnicon Jacklyn Minnicon Marlene
Minnicon Marlees Mungatopi Gerarda Munkara Una
Pilakui
Kevin Portaminni Vicky Pungatji Marius
Puruntatameri Elaine Tiparui Camilla
Tipiloura Marie Rose Tipiloura Mary-Lou
Tipungwuti Wendy Tipiloura Mareen
Tipuamantumerri
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Other Information
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Acute Otitis Media
Pneumococcus NT Haemophilus Moraxella (Gp A
Strep) RSV Rhinovirus Coronavirus Influenza Para
influenza Adenovirus Enterovirus
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Spectrum of Otitis Media
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Diagnosis
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How Common is OM?
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Severe OM by Isolation (0-3y)
WAACHS survey 2005
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What Causes Severe OM?
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Pneumococcal Carriage
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Our (Aboriginal) OM Summary

• Early, heavy colonisation with bacterial
  respiratory pathogens
• Early onset of OM
• AOM asymptomatic
• AOM persistent
• Large differences between communities
• Substantial improvement possible
• Antibiotics prevent perforation
• Long-term treatment (surveillance) required for
  CSOM but improvement seen early.

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What Can Be Done?

• Options for reducing rates of severe otitis
  media
• Health education
• Modifying hygiene practices
• Immunisation
• Antibiotics
• Case management

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Understanding the Biology
Susceptibility, Exposures, Treatment Factors
EXPOSURE TO RESPIRATORY BACTERIA
HIGH DOSE
LOW DOSE
Clearance
Persistent Nasal Discharge
Normal Carriage
Carriage with Inflammation
Vicious Circle
Acute Disease OM, Pneumonia and Invasive Disease
Chronic Bacterial Mucosal Disease