Lehmann Deborah, Weeks Sharon, Jacoby Peter, Elsbury Dimity, Finucane Janine, Stokes Annette, Monck Ruth, Coates Harvey
Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Australia.
BMC Pediatr. 2008 Aug 28;8:32. doi: 10.1186/1471-2431-8-32.
Otitis media (OM) is the most common paediatric illness for which antibiotics are prescribed. In Australian Aboriginal children OM is frequently asymptomatic and starts at a younger age, is more common and more likely to result in hearing loss than in non-Aboriginal children. Absent transient evoked otoacoustic emissions (TEOAEs) may predict subsequent risk of OM.
100 Aboriginal and 180 non-Aboriginal children in a semi-arid zone of Western Australia were followed regularly from birth to age 2 years. Tympanometry was conducted at routine field follow-up from age 3 months. Routine clinical examination by an ENT specialist was to be done 3 times and hearing assessment by an audiologist twice. TEOAEs were measured at ages <1 and 1-2 months. Cox proportional hazards model was used to investigate the association between absent TEOAEs and subsequent risk of OM.
At routine ENT specialist clinics, OM was detected in 55% of 184 examinations in Aboriginal children and 26% of 392 examinations in non-Aboriginal children; peak prevalence was 72% at age 5-9 months in Aboriginal children and 40% at 10-14 months in non-Aboriginal children. Moderate-severe hearing loss was present in 32% of 47 Aboriginal children and 7% of 120 non-Aboriginal children aged 12 months or more. TEOAE responses were present in 90% (46/51) of Aboriginal children and 99% (120/121) of non-Aboriginal children aged <1 month and in 62% (21/34) and 93% (108/116), respectively, in Aboriginal and non-Aboriginal children at age 1-2 months. Aboriginal children who failed TEOAE at age 1-2 months were 2.6 times more likely to develop OM subsequently than those who passed. Overall prevalence of type B tympanograms at field follow-up was 50% (n = 78) in Aboriginal children and 20% (n = 95) in non-Aboriginal children.
The burden of middle ear disease is high in all children, but particularly in Aboriginal children, one-third of whom suffer from moderate-severe hearing loss. In view of the frequently silent nature of OM, every opportunity must be taken to screen for OM. Measurement of TEOAEs at age 1-2 months to identify children at risk of developing OM should be evaluated in a routine health service setting.
中耳炎（OM）是最常使用抗生素治疗的儿科疾病。在澳大利亚原住民儿童中，中耳炎常常没有症状，发病年龄更小，比非原住民儿童更常见，也更易导致听力损失。瞬态诱发耳声发射（TEOAEs）缺失可能预示着后续患中耳炎的风险。
对西澳大利亚半干旱地区的100名原住民儿童和180名非原住民儿童从出生到2岁进行定期跟踪。3个月大时在常规现场随访中进行鼓室图检查。耳鼻喉科专家进行3次常规临床检查，听力学家进行2次听力评估。在小于1个月和1 - 2个月时测量TEOAEs。采用Cox比例风险模型研究TEOAEs缺失与后续患中耳炎风险之间的关联。
在常规耳鼻喉科专家诊所，184次对原住民儿童的检查中，55%检测到中耳炎，392次对非原住民儿童的检查中，26%检测到中耳炎；原住民儿童在5 - 9个月时发病率最高，为72%，非原住民儿童在10 - 14个月时发病率最高，为40%。在47名12个月及以上的原住民儿童中，32%有中度至重度听力损失，在120名非原住民儿童中，7%有中度至重度听力损失。在小于1个月的原住民儿童中，90%（46/51）有TEOAE反应，非原住民儿童中99%（120/121）有TEOAE反应；在1 - 2个月时，原住民儿童和非原住民儿童中TEOAE反应的比例分别为62%（(21/34）和93%（108/116）。1 - 2个月时TEOAE检测未通过的原住民儿童随后患中耳炎的可能性是非通过儿童的2.6倍。现场随访中，原住民儿童B型鼓室图的总体患病率为50%（n = 78），非原住民儿童为20%（n = 95）。
所有儿童中耳疾病负担都很高，尤其是原住民儿童，其中三分之一患有中度至重度听力损失。鉴于中耳炎常常没有症状，必须利用一切机会筛查中耳炎。应在常规医疗服务环境中评估在1 - 2个月时测量TEOAEs以识别有患中耳炎风险儿童的方法。
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