Transcript How will I use this new information?

Dr Ruth Thornton
Otitis media – a multi-factorial disease
requiring a multi-faceted approach
A/Prof Amanda J Leach
OMOZ_2012
Conceptual framework to study causal pathways to Otitis Media (Lehmann et al.)
Colonisation of
Australia
Marginalisation
Fixed
settlements
Maternal
age
Housing
Seasons
Crowding
Psychosocial
problems
Education
Employment
Siblings
Daycare
Lack of water
Smoking
Single parent
Pacifier
Poor
nutrition
Not
Breastfed
Coughers
High rates of
transmission
Impaired immunity
(young age, suppression, tolerance)
Bacterial carriage, Prolonged, Multiple
Early age NP
colonisation
Poor hygiene
Viruses
OTITIS MEDIA
Educational & social
disadvantage
Hearing loss
Family history
OM or
allergy
Parental
smoking
Genetics
Male sex
Conceptual framework to study causal pathways to Otitis Media (Lehmann et al.)
Colonisation of
Australia
Marginalisation
Fixed
settlements
Maternal
age
Housing
Seasons
Crowding
Psychosocial
problems
Education
Employment
Siblings
Daycare
Lack of water
Smoking
Single parent
Pacifier
Poor
nutrition
Not
Breastfed
Coughers
High rates of
transmission
Impaired immunity
(young age, suppression, tolerance)
Bacterial carriage, Prolonged, Multiple
Early age NP
colonisation
Poor hygiene
Viruses
OTITIS MEDIA
Educational & social
disadvantage
Hearing loss
Family history
OM or
allergy
Parental
smoking
Genetics
Male sex
8 ALGORITHMS
OMOZ_2012
Spectrum of otitis media :
Otitis media with effusion, OME to CSOM
“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
OMOZ_2012
National Trachoma Eye Health Program
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
Ear disease in rural Australia. Moran et al. MJA 1979.
OMOZ_2012
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.
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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.
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2 NOVEMBER 2009
VOLUME 191 NUMBER 9
Theories of otitis media pathogenesis, with a focus on Indigenous children
Selma P Wiertsema and Amanda J Leach — Med J Aust 2009; 191 (9): S50S54.
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.
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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.
•
Surgery for otitis media among Indigenous Australians
Stephen J O’Leary and Ross D Triolo — Med J Aust 2009; 191 (9): S65-S68.
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SUPPLEMENT
Otitis media: viruses, bacteria, biofilms and vaccines
Helen M Massa, Allan W Cripps and Deborah Lehmann — Med J
Aust 2009; 191 (9): S44-S49.
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MJA
Otitis media 2009: an update
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.
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.
2000 to April 2009
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 1968.
• Chronic ear disease in aborigines – a research programme. Beaumont. J Otolaryngol
Soc Aust 1972.
• Challenging aspects of ENT disease among aboriginal children. Willis. J Otolaryngol
Soc Aust 1972.
• A microbiologist looks at aboriginal health. Doherty. MJA 1974.
• Aboriginal health in Mornington Island, 1971. Bolin et al. MJA 1975.
• Factors leading to chronic ear disease. Canty et al. MJA 1975. “…aboriginal …”
• Influence of nutrition and social conditions on school performance of aboriginal
children. Dugdale. MJA 1975
• Otitis media and linguistic incompetence. Lewis Arch Otolaryngol 1976. “..aboriginal..”
• Serotypes of pneumococci in pneumonia, meningitis and other.. Hansman D. ANZJMed
1977.
• The natural history of chronic middle ear disease in Australian Aboriginals: a crosssectional study. Dugdale etal. MJA 1978.
• Pneumococcal disease and it’s prevention --- a review. Douglas Riley ANZJMed 1979.
“…aborigines.. otitis media ..”
• Ear disease in rural Australia. Moran et al. MJA 1979. “Aboriginal and non-Aboriginal ..”
• ……
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 1983.
• An environmental and demographic analysis of otitis media in ..aborigines.
Hudson & Rocket 1984.
• Microbiology of chronic OME .. Aboriginal: Chlamydia. Dawson et al. Aust J
Exp Biol Med Sci. 1985.
• OM in the Australian Aboriginal. Willis Am J otol 1985.
• Aboriginal child health. Stuart. Aust Fam Physician 1985.
1990s
• Causes of CSOM in ..aboriginal ..infants. McConnel et al. 1991
1993 – first studies not to include aboriginal
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Short term efficacy of TTs ..OM in Down Syndrome.
Other surgery - tonsillectomy, grommets, cochlear, mastoiditis
Pneumococcal epidemiology 1994
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Bacterial colonisation ..aboriginal infants. Leach et al. PIDJ
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 (EarInfoNet)
Morris et al. 2009. MJA.
……………It’s everywhere
Vaccines, antibiotics, hygiene,
guidelines, trials, pneumococcology
Ear health (EarInfoNet)
Epi
RCT: topical antibiotics
Speech
Fruit
Swimming pools
Viruses &
bacteria
KalOM cohorts.
Risk factors.
Smoke. Crowding
Cochrane
Systematic
reviews
Animal
models:
polymicrobial
Biofilm
Immunology.
Genetics
Smell
Molecular biology
teleotoscopy
OMOZ_2012
Surgery
OMOZ_2012
The OMOZ PROGRAM over 3 days
DAY 1
Session 1: 11am – 1pm
Bacterial infections and their impact on otitis media
development, treatment and outcomes
Invited speaker & Chair: Professor Janelle Kyd
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?
OMOZ_2012
DAY 1
Session 2: 2-3.20pm
Current, new, and future vaccines and other
interventions: how are these likely to impact on
otitis media?
Invited Speaker & Chair: Professor Peter
Richmond.
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?
OMOZ_2012
DAY 1
Session 3: 3.50 -5.20pm
Immune responses to otitis media pathogens and
disease outcome, and genetic predisposition to
otitis media
Invited speaker and Chair: Professor Allan
Cripps.
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?
OMOZ_2012
DAY 2
Session 1: 9-10.20am
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
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?
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Swimming
Vaccines in combination
Tympanic membrane engineering
Coming unstuck – dissolving glue ear
• How will I use this new information?
OMOZ_2012
DAY 2
Session 2: 10.50am -12.15pm
Surveillance and epidemiology of otitis media.
Prevalence, risk factors, treatment and prevention
Invited speakers and Chairs –
Associate Professor Deborah Lehmann
Associate Professor Peter Morris
OMOZ_2012
DAY 2: Surveillance and epidemiology of otitis media.
Prevalence, risk factors, treatment and prevention
• What’s new?
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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?
OMOZ_2012
DAY 2
Session 3: 1.30-3.10pm
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
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?
OMOZ_2012
DAY 2
Session 4: 3.40-4.45pm
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
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?
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
OMOZ_2012
DAY 3: Life course impacts of OM
• What’s new?
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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?
OMOZ_2012
DAY 3
Session 2: 11.10-12.35pm
How do we go about improving hearing health for
all children?
Chair: Samantha Harkus
OMOZ_2012
DAY 3:Improving hearing health for all children?
• What’s new?
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Victorian strategy
Fighting disease with fruit
Urban GPs experience
Managing hearing information
Resource development in the community
• How will I use this new information?
OMOZ_2012
DAY 3
PANEL DISCUSSION
Setting priorities for research & advocacy
Plans/bids for OMOZ 2014.
OMOZ_2012