How can we create equitable access to hearing healthcare in Australia? Interview with Prof. Tom Calma, Prof. Kelvin Kong and Hon. A/Prof. Boe Rambaldini.

Despite decades of research demonstrating that early intervention is critical to diagnosing and treating ear disease in Aboriginal and Torres Strait Islander children, not enough progress has been made in providing culturally safe, accessible and equitable hearing health services. In the discussion below, Aboriginal and Torres Strait Islander health leaders Professor Tom Calma, Professor Kelvin Kong and Associate Professor Boe Rambaldini examine the problems and solutions for creating better services to meet the needs of communities where hearing health problems are being neglected, often with catastrophic results for Aboriginal and Torres Strait Islander children and their families.

'Sometimes they're gammin, playing tricks, but sometimes it's ears.' The perspectives of urban parents and carers of young Aboriginal and Torres Strait Islander children on their journey to diagnosis of persistent ear health and hearing problems.

OBJECTIVES: Data presented in this paper were gathered during the Urban Hearing Pathways study. The objective of the study was to investigate how access to, and availability of, ear health and hearing services contributes to the burden of avoidable hearing loss experienced by young, urban Aboriginal and Torres Strait Islander children and their families. The objective of this paper is to present the perspectives of parents and carers about awareness and concern in their community, detection and diagnosis of children's ear health and hearing problems in primary care, and impacts of delays in diagnosis on children and families. These perspectives are complemented by those of health professionals. Importance of study: The study findings address an evidence gap relating to factors that prompt an ear health and hearing check for young, urban Aboriginal and Torres Strait Islander children. They reveal the difficulties families experience in establishing a diagnosis of chronic ear disease and receiving the care they perceive will effectively addresses their child's needs. STUDY TYPE: Qualitative study with surveys. METHODS: The project team consisted of six Aboriginal researchers and 10 non-Indigenous researchers. Data collection tools and methods were designed by the project team. A total of 33 parents and carers completed surveys, and most also took part in interviews (n = 16) or focus groups (n = 16); 23 described their child's ear health journey. Fifty-eight service providers from the health, early childhood and community service sectors completed anonymous surveys and 26 were interviewed. Descriptive statistics were generated from survey data and thematic analysis was conducted for interview and focus group data. RESULTS: Five main themes emerged from the analysis of parent and carer interviews: community knowledge and parent/carer recognition of signs of ear health and hearing problems; parent and carer action-taking; getting ear health and hearing checks; recognition of persistent problems; and impacts of delays on children and families. CONCLUSIONS: Reiterating previous findings, there is no evidence of a systematic approach to ear checks for this at-risk population. A significant proportion of parents and carers are noticing problems by watching their child's listening behaviours: early and reliable indicators of hearing status that can be harnessed. Some persistent ear health problems are being managed in primary care as acute episodes, thus delaying specialist referral and increasing developmental impacts on the child. Parents' and carers' practical recommendations for improving hearing health services are presented.

Agreement between diagnoses of otitis media by audiologists and otolaryngologists in Aboriginal Australian children.

OBJECTIVES: To determine the degree of agreement of diagnoses by audiologists and otolaryngologists of otitis media (OM) in Aboriginal children. DESIGN: Cross-sectional study of agreement between diagnoses. SETTING: Study of Environment on Aboriginal Resilience and Child Health (SEARCH), a prospective cohort study of Aboriginal children attending four Aboriginal Community Controlled Health Services in New South Wales (three metropolitan, one regional) during 2008-2012. PARTICIPANTS: 1310 of 1669 SEARCH participants (78.5%; mean age, 7.0 years; SD, 4.4 years) were assessed and received a diagnosis from one of five experienced audiologists. Test results (but not case histories) were forwarded to one of three otolaryngologists for blinded independent assessment. MAIN OUTCOME MEASURES: Agreement of OM diagnoses by audiologists and otolaryngologists at ear and child levels; correctness of audiologist diagnoses (otolaryngologist diagnosis as reference). RESULTS: Paired diagnoses by audiologists and otolaryngologists were available for 863 children at the child level and 1775 ears (989 children) at the ear level. Otolaryngologists diagnosed OM in 251 children (29.1%), including 11 (1.3%) with tympanic membrane perforation, and in 396 ears (22.3%), including 12 (0.7%) with perforation. Agreement between audiologists and otolaryngologists for OM at the ear level was 92.2% (κ = 0.78; 95% CI, 0.74-0.82), and at the child level 91.7% (κ = 0.81; 95% CI, 0.77-0.85). No otolaryngologist-diagnosed perforation was missed by audiologists. Among 1000 children triaged by an audiologist, there would be 45 false positives and 30 false negatives when compared with assessments by an otolaryngologist, with no missed perforations. CONCLUSIONS: There was substantial agreement between audiologists' and otolaryngologists' diagnoses of OM in a high prevalence population of Aboriginal children. In settings with limited access to otolaryngologists, audiologists may appropriately triage children and select those requiring specialist review.