Media release

From: Medical Journal of Australia (MJA)

GUIDELINES, APP FOR BEST PRACTICE IN OTITIS MEDIA

THE 2020 otitis media guidelines and a new smartphone app improve access to the most up-to-date evidence on best practice in otitis media and hearing loss prevention and management for Aboriginal and Torres Strait Islander children.

In remote communities across Australia, only one in 10 Aboriginal children under the age of 3 years has healthy ears. Five have otitis media (OM) with effusion, or “glue ear”; and four have suppurative OM — acute OM with or without perforation or chronic suppurative OM; three in 10 have disabling hearing impairment.

Childhood chronic OM and hearing impairment can affect communication, relationships, and quality of life from soon after birth through toddler years, schooling, and later employment opportunities. Improved ear and hearing health are critical to Closing the Gap outcomes and targets.

Published in the Medical Journal of Australia, a summary of the guidelines outlines changes in management as a result of systematic reviews of the evidence.

Led by Professor Amanda Leach AM, Senior Principal Research Fellow at the Menzies School of Health Research in Darwin, the authors reported 10 “algorithms to guide diagnosis and clinical treatment”, including 14 prevention and 37 treatment strategies.

Changes in management as a result of the guidelines:

• A GRADE approach is used
• Targeted recommendations for both high and low risk children.
• New tympanostomy tube otorrhoea section.
• New Priority 5 for health services: annual and catch-up ear health checks for at-risk children.
• Antibiotics are strongly recommended for persistent otitis media with effusion in high risk children.
• Azithromycin is strongly recommended for acute otitis media where adherence is difficult or there is no access to refrigeration.
• Concurrent audiology and surgical referrals are recommended where delays are likely.
• Surgical referral is recommended for chronic suppurative otitis media at the time of diagnosis.
• The use of autoinflation devices is recommended for some children with persistent otitis media with effusion.
• Definitions for mild (21–30 dB) and moderate (> 30 dB) hearing impairment have been updated.
• New “OM app” developed to enable free fast access to the guidelines, plus images, animations, and multiple Aboriginal and Torres Strait Islander language audio translations to aid communication with families.

The new digital app and website, OMapp, have been designed to be used in the clinic, and has four sections:

• Clinical (diagnosis and management): algorithms for all types of OM.
• Communicate: audio recordings in multiple Aboriginal languages to assist the caregivers’ understanding of messages and instructions regarding their child’s ear health and hearing needs.
• Education: includes pneumatic otoscopy videos and a quiz and cartoons to explain hearing loss simulation, how the ear works, how ear infections can be prevented, and understanding referral pathways.
• Guidelines: evidence summaries for all prevention and treatment strategies, recommendations and their strength, quality and confidence, effect size, overall benefit, “what happens” PICOT statements, and links to GRADEpro summary of findings tables.

“The 2020 OM guidelines and the new OMapp improve access to the most up-to-date critically appraised evidence on best practice in OM and hearing loss prevention and management for Aboriginal and Torres Strait Islander children across all Australian settings.” Leach and colleagues concluded.

The full guidelines and links to download the app are available at https://otitismediaguidelines.com