New hope for chronic middle ear infection in Aboriginal children

Chronic middle ear infection which leads to perforation of the ear drum is a major cause of hearing impairment among Australian Indigenous children living in remote communities.

Research results of the NACCHO (National Aboriginal Community Controlled Health Organisation) Ear Trial, published in the current issue of the Medical Journal of Australia, compared the effectiveness of two antibiotic ear drops - ciprofloxacin (CIP) and framycetin, gramicidin, dexamethasone (FGD) - used in conjuction with twice daily ear cleaning, in the treatment of Chronic Suppurative Otitis Media (CSOM) in Aboriginal children.

CSOM is a middle ear infection that lasts for at least two weeks and includes a perforated ear drum (tympanic membrane perforation).

The study involved 147 Aboriginal children with CSOM. One hundred and eleven children aged 1-14 years from eight Aboriginal Community Controlled Health Services across northern Australia completed the treatment. Fifty five were treated with CIP and 56 with FGD. Sixty four per cent of the children were cured of CSOM. Over 75 per cent of the children treated with CIP were cured, compared with just over 50 per cent of those treated with FGD.  The trial found no evidence that the use of topical CIP led to antibiotic resistance in the bacteria isolated from the ear.

The Chair of NACCHO, Mr Henry Councillor, said given the findings of the study, Australian federal authorities should consider making topical CIP or other fluorquinolones available, as a matter of urgency, as first-line treatment for CSOM in Aboriginal children.

"Although in wide use internationally for CSOM, including the USA, this treatment is currently not approved by the Therapeutic Goods Administration," Mr Councillor said.

Fluoroquinolones are non-toxic when administered into the middle ear, and there is negligible systemic absorption in children.

"CSOM is a disease of poverty.  It is very common among Australian Aboriginal children, with the prevalence exceeding the World Health Organisation's definition of a massive public health problem," Mr Councillor said.

Co-author of the research, Dr Sophie Couzos, from NACCHO said that research in 1998-2001 showed that 23 per cent of Aboriginal children from remote regions of the Northern Territory had evidence of perforated tympanic membranes.

"In Aboriginal children, CSOM usually commences in infancy, is evident within a few weeks of birth, causes hearing loss and has an adverse effect on child development," Dr Couzos said. 

She said CSOM is recurrent, can persist into adulthood and can lead to hospitalization.

"The children in our study had well recognized risk factors for CSOM," Dr Couzos said.

"These include serious overcrowding in dwellings, a high proportion of CSOM among siblings and contacts, and significant passive exposure to cigarette smoke.

"While only 0.5 per cent of the general Australian population had seven or more people resident in three bedroom dwelling in 1996, this was the norm for 54 per cent of our children.

"The proportion passively exposed to cigarette smoke (68.5 per cent) is also much higher than smoking prevalence among parents of infants in the general population (28.9 per cent).

"These data underscore the need to address economic, social and environmental inequities faced by the Aboriginal population," Dr Couzos said.

The NACCHO Ear Trial is the first Aboriginal community-controlled, multicentre, double-blind, randomized controlled trial among Aboriginal children in Australia to compare the effectiveness of CIP and FGD for treating CSOM in Aboriginal children.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT:    Mr Henry Councillor (0419 929 422)or Dr Sophie Couzos, (0417 178 514)

                  Judith Tokley, AMA, 02 6270 5471/0408 824 306