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

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Presentation on theme: "OMOZ_2012 Otitis media – a multi-factorial disease requiring a multi-faceted approach A/Prof Amanda J Leach Dr Ruth Thornton."— Presentation transcript:

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

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

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

4 OMOZ_ ALGORITHMS

5 OMOZ_2012 “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 Spectrum of otitis media : Otitis media with effusion, OME to CSOM

6 OMOZ_2012 National Trachoma Eye Health Program Ear disease in rural Australia. Moran et al. MJA 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

7 Med J Aust supplement on Otitis media 2009 Current management of otitis media in Australia — foreword Harvey L C Coates — Med J Aust 2009; 191 (9): S37. Current management of otitis media in Australia — foreword 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. Natural history, definitions, risk factors and burden of otitis media Otitis media: viruses, bacteria, biofilms and vaccines Helen M Massa, Allan W Cripps and Deborah Lehmann — Med J Aust 2009; 191 (9): S44-S49. Otitis media: viruses, bacteria, biofilms and vaccines 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. Theories of otitis media pathogenesis, with a focus on Indigenous children 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. Primary care management of otitis media among Australian children 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. Complications of otitis media in Indigenous and non-Indigenous children Surgery for otitis media among Indigenous Australians Stephen J O’Leary and Ross D Triolo — Med J Aust 2009; 191 (9): S65-S68. Surgery for otitis media among Indigenous Australians 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. The impact of otitis media on cognitive and educational outcomes 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. New horizons: otitis media research in Australia Otitis media 2009: an update MJA SUPPLEMENT 2 NOVEMBER 2009 VOLUME 191 NUMBER 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 Chronic ear disease in aborigines – a research programme. Beaumont. J Otolaryngol Soc Aust Challenging aspects of ENT disease among aboriginal children. Willis. J Otolaryngol Soc Aust A microbiologist looks at aboriginal health. Doherty. MJA Aboriginal health in Mornington Island, Bolin et al. MJA Factors leading to chronic ear disease. Canty et al. MJA “… aboriginal …” Influence of nutrition and social conditions on school performance of aboriginal children. Dugdale. MJA 1975 Otitis media and linguistic incompetence. Lewis Arch Otolaryngol “.. aboriginal..” Serotypes of pneumococci in pneumonia, meningitis and other.. Hansman D. ANZJMed The natural history of chronic middle ear disease in Australian Aboriginals : a cross- sectional study. Dugdale etal. MJA Pneumococcal disease and it’s prevention --- a review. Douglas Riley ANZJMed “… aborigines.. otitis media..” Ear disease in rural Australia. Moran et al. MJA “ 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 An environmental and demographic analysis of otitis media in.. aborigines. Hudson & Rocket Microbiology of chronic OME.. Aboriginal : Chlamydia. Dawson et al. Aust J Exp Biol Med Sci OM in the Australian Aboriginal. Willis Am J otol Aboriginal child health. Stuart. Aust Fam Physician s Causes of CSOM in.. aboriginal..infants. McConnel et al – first studies not to include aboriginal Short term efficacy of TTs..OM in Down Syndrome. Other surgery - tonsillectomy, grommets, cochlear, mastoiditis Pneumococcal epidemiology –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 (Ear InfoNet ) Morris et al MJA.

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

12 OMOZ_2012

13 The OMOZ PROGRAM over 3 days

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

15 OMOZ_2012 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?

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

17 OMOZ_2012 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?

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

19 OMOZ_2012 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?

20 OMOZ_2012 DAY 2 Session 1: am 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

21 OMOZ_2012 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?

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

23 OMOZ_2012 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?

24 OMOZ_2012 DAY 2 Session 3: pm 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

25 OMOZ_2012 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?

26 OMOZ_2012 DAY 2 Session 4: pm 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

27 OMOZ_2012 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?

28 OMOZ_2012 DAY 3 Session 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

29 OMOZ_2012 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?

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

31 OMOZ_2012 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?

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


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