Ear and hearing health is important to overall health and quality of life. Poor ear health and hearing loss can have long-lasting impacts on education, wellbeing and employment. Aboriginal and Torres Strait Islander children experience some of the highest rates of ear disease and associated hearing loss in the world (WHO 2004).

While ear disease is a common childhood illness, often accompanying a cold or flu, Indigenous children are more likely than non-Indigenous children to develop ear disease at a younger age, and experience greater frequency and severity of infections (Jervis-Bardey et al. 2014). Otitis media—inflammation and/or infection of the middle ear—is the main condition contributing towards hearing loss in Indigenous children (Burns & Thomson 2013).

Ear disease and associated hearing loss are largely preventable. Poor ear and hearing health is associated with household overcrowding, hygiene practices, second-hand smoke exposure, a poor diet and lack of access to medical services (Burns & Thomson 2013; Kong & Coates 2009). Experiencing hearing loss in childhood can affect speech and language development, and may lead to behavioural problems, early school leaving, limited employment options and increased contact with the criminal justice system (Burns & Thomson 2013). See ‘Housing conditions and key challenges in Indigenous health‘ in Australia’s health 2020: data insights.

Ear and hearing problems among Indigenous Australians

Self-reported ear and hearing problems

In 2018–19, based on self-reported data from the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), an estimated 14% (111,700) of Indigenous Australians had a long-term ear/hearing problem. The proportion was the same for men and women (14%), and similar for Remote (13%) and Non-remote (14%) areas (ABS 2019b) (Figure 1).

Ear and hearing problems increased with age. Indigenous Australians aged over 55 had the highest proportion of ear/hearing problems (34%), with deafness accounting for the majority of problems (30%). Children aged 0–14 were more likely to have otitis media than older age groups (2.6% compared with 0.2%–1.0%, respectively) (ABS 2019b).
 

This chart shows the proportion of Indigenous Australians with an ear/hearing problem by remoteness. The proportion of ear/hearing problems among Indigenous Australians was similar for Non-remote (14.0%) and Remote (12.9%) areas.

The proportion of Indigenous Australians with a self-reported long-term ear/hearing problem was similar between 2001 and 2018–19 (Table 1). However, for Indigenous children aged 0–14, the proportion with an ear/hearing problem decreased from 11.2% to 6.9% over the same period (ABS 2019b, AIHW 2018).

Table 1: Indigenous Australians with a self-reported long-term ear/hearing problem, 2001 to 2018–19

Year

Total (per cent)

Total children aged 0–14 (per cent)

 2001

14.6

11.2

2004–05

12.2

9.5

2012–13

12.3

7.1

2018–19

13.7

6.9

 

Source: ABS 2019b; AIHW 2018.

Indigenous Australians were more likely than non-Indigenous Australians to have ear/hearing problems

Based on age-standardised proportions, compared with non-Indigenous Australians, Indigenous Australians were:

  • 1.4 times as likely to have a long-term ear/hearing problem
  • 3 times as likely to have otitis media (ABS 2019a).

Among children aged 0–14, Indigenous Australians were:

  • twice as likely to have a long-term ear/hearing problem
  • 3 times as likely to have otitis media (ABS 2019a, 2019b).

The proportions of Indigenous and non-Indigenous children with self-reported long-term ear/hearing problems decreased between 2001 and 2017–19 (ABS 2019a, 2019b; AIHW 2018).

Measured hearing loss

For the first time, the 2018–19 NATSIHS included a hearing test, which aims to provide a national picture on hearing loss in Indigenous Australians.

In 2018–19, an estimated 43% (290,400) of Indigenous Australians aged 7 and over were found to have hearing loss in one or both ears during the NATSIHS hearing test. The proportion was similar between men (43%) and women (42%), and increased with age (from 29% for 7–14 years to 82% for 55 years and over) (ABS 2019b).

The proportion of Indigenous Australians with measured hearing loss was higher in Remote (59%) than Non-remote (39%) areas. It also varied across states and territories, from 33% in Victoria to 60% in the Northern Territory (ABS 2019b) (Figure 2).

The proportion of Indigenous Australians with measured hearing loss (43%) was higher than self-reported hearing loss (12%) among those aged 7 and over (Figure 2).
 

This chart shows the proportion of Indigenous Australians with measured and self-reported hearing loss varies by remoteness. For measured hearing loss: 34.3% for Major citites; 40.2% for Inner regional; 46.1% for Outer regional; 53.5% for Remote and 62.0% for Very remote areas. For self-reported hearing loss: 10.4% for Major citites; 13.8% for Inner regional; 11.7% for Outer regional; 13.8% for Remote and 10.0% for Very remote areas.

The majority (79%) of Indigenous Australians who had measured hearing loss did not self-report a long-term hearing problem. This could be due to several factors including undiagnosed hearing loss, short-term hearing loss due to a temporary cause such as a cold, or limitations with the hearing test (ABS 2019b).

The proportion of Indigenous Australians with measured hearing loss who did not self-report hearing loss generally decreased with increasing age (from 92% for 7–14 years to 67% for 55 years and over), and was higher in Remote (84%) than Non-remote (77%) areas (ABS 2019b) (Figure 3).
 

This shows the proportion of Indigenous Australians with measured hearing loss who did not also self-report long-term hearing loss increases with increasing remoteness. Major citites: 77.7%,  Inner regional: 72.2%, Outer regional: 79.2%, Remote: 80.0% and Very remote: 86.1%.

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Treatment and management

Hospitalisations

Hospitalisations for diseases of the middle ear and mastoid process reflect use of health services, rather than the prevalence of these conditions in the community.

Between July 2015 and June 2017, there were 4,522 hospitalisations for Indigenous children aged 0–14 for diseases of the middle ear and mastoid process. The age-standardised hospitalisation rate for Indigenous children was higher than for non-Indigenous children (8.1 compared with 6.7 per 1,000, respectively) (AIHW forthcoming 2020).

For Indigenous children, the rate increased after 2007–08 and may reflect improved diagnosis and use of ear health services. The rate for non-Indigenous children has remained relatively stable since 2004–05 (Figure 4) (AIHW forthcoming 2020).
 

This chart shows the rate of hospitalisations for diseases of the middle ear and mastoid process for Indigenous and non-Indigenous children between 2004–05 and 2016–17. For Indigenous children, the rate increased from 5.7 per 1,000 in 2004–05 to 8.5 per 1,000 in 2017–17. For non-Indigenous children, the rate decreased from 7.6 per 1,000 to 6.6 per 1,000.

Assistive hearing devices

Hearing Australia provides government-funded audiology services and hearing aids to Australian children and young people aged under 26 with permanent or long-term hearing loss. Since June 2019, Hearing Australia’s Hearing Assessment Program—Early Ears has also provided early identification and intervention services to Indigenous children aged 0–5 in rural areas.

In 2018, of the 25,381 children and young people who were fitted with a hearing aid or cochlear implant through Hearing Australia, 1 in 11 (9%) were Indigenous. In the Northern Territory, Indigenous children accounted for the majority (81%) of children newly fitted with an assistive hearing device. Non-Indigenous children are more likely to receive an assistive hearing device at a younger age compared with Indigenous children, although with targeted early diagnosis and intervention, the gap has started to decrease in recent years (Hearing Australia 2019).

Hearing health programs

A range of Australian and state government programs aimed at decreasing the prevalence of ear disease and hearing loss have been implemented over time. A variety of programs exists focusing on promotion, prevention and early treatment of ear disease and hearing loss, such as the Australian Government’s Care for Kids’ Ears campaign, neonatal hearing screening programs and outreach programs such as the Northern Territory Remote Aboriginal Investment (NTRAI) Hearing Health Program (AIHW 2014).

Hearing health services in the Northern Territory

For the past decade the Australian Government has funded the Northern Territory Government to provide hearing health services to Indigenous children and young people aged under 21 in the Northern Territory. In 2018, 1,817 children and young people received at least 1 service through the NTRAI Hearing Health Program Among these:

  • 3 in 5 (61%) were diagnosed with at least 1 ear condition. Among these children, the majority (68%) also experienced hearing loss
  • younger children were more likely to have an ear condition, with 73% of children aged 0–2 and 61% of those aged 3–5 having at least 1 ear condition (AIHW 2019).

Nearly half (47%) of children who received an audiology service in 2018 had hearing loss. The most common type of hearing loss was conductive (28%), which is associated with chronic ear disease (AIHW 2019). 

Children who received hearing health services through the NTRAI Hearing Health Program have had improvements in ear health and a reduction in hearing loss over time. Between 2012 and 2018:

  • the percentage of children and young people with at least 1 ear disease decreased from 66% to 61%
  • the percentage of children and young people with hearing loss decreased from 55% to 47%.

Children who received multiple services over time had a larger reduction in ear disease. For children and young people who received at least 2 services between July 2012 and December 2018, the proportion with at least 1 ear condition decreased by 22 percentage points between the first and last service (from 76% to 54%) (AIHW 2019).

Where do I go for more information?

For more information on Indigenous hearing health, see:

Visit Indigenous Australians for more on this topic.

References

ABS (Australian Bureau of Statistics) 2019a. Microdata: National Health Survey, 2017–18. ABS cat. no. 4324.055.00. Findings based on Detailed Microdata analysis. Canberra: ABS.

ABS 2019b. National Aboriginal and Torres Strait Islander Health Survey, 2018–19. ABS cat. no. 4715.0. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2014. Ear disease in Aboriginal and Torres Strait Islander children. Resource sheet no. 35 produced by the Closing the Gap Clearinghouse. Canberra: AIHW.

AIHW 2018. Australia's health 2018. Cat. no. AUS 221. Canberra: AIHW.

AIHW 2019. Hearing health outreach services for Aboriginal and Torres Strait Islander children in the Northern Territory: July 2012 to December 2018. Cat. no. IHW 213. Canberra: AIHW.

AIHW forthcoming 2020. Aboriginal and Torres Strait Islander Health Performance Framework (HPF) report 2020. Canberra: AIHW.

Burns J & Thomson N 2013. Review of ear health and hearing among Indigenous Australians. Australian Indigenous Health Bulletin 13(4):1–22.

Hearing Australia 2019. Aided child demographics 2018. Sydney: Hearing Australia.

Jervis-Bardy J, Sanchez L & Carney A 2014. Otitis media in Indigenous Australian children: review of epidemiology and risk factors. The Journal of Laryngology & Otology S16–S27. doi:10.1017/S0022215113003083.

Kong K & Coates H 2009. Natural history, definitions, risk factors and burden of otitis media. Medical Journal of Australia 91(9):S39 doi:10.5694/j.1326-5377.2009.tb02925.x.

WHO (World Health Organization) 2004. Chronic suppurative otitis media: burden of illness and management options. Geneva: WHO.