Ear and hearing conditions

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Prevalence and impacts

The Aboriginal and Torres Strait Islander (First Nations) population has elevated rates of ear and hearing problems. In 2018–19, more than 2 in 5 First Nations people aged 7 and over were assessed as having some degree of hearing loss.

Many people spend years living with hearing loss and other ear or hearing related conditions. In 2018, the burden of living with ear or hearing related conditions for First Nations people was 3.6 times that of non-Indigenous Australians. This is based on a measure of years lived with disability per 1,000 population, adjusted to account for differences in the age profile of the two populations (AIHW 2022).

First Nations children have some of the highest rates of ear disease and related hearing loss in the world (WHO 2004). Middle ear infection, or otitis media, is a major cause of ear and hearing problems in First Nations children (Burns and Thomson 2013, Coates et al. 2002). Apart from hearing loss caused by genetic conditions and ageing, much of the hearing loss experienced by First Nations people is preventable or amenable to treatment. Worldwide, an estimated 60% of childhood hearing loss is due to preventable causes (WHO 2024).

In young children, ear and hearing problems can lead to delays in speech and language development and hamper cognitive, behavioural and social development, which in turn can affect schooling and educational achievement (Menzies School of Health Research 2023, Su et al. 2020, Wong et al. 2018).

Later in life, ear and hearing problems can be a barrier to employment opportunities and can lead to strained relationships and isolation from community and culture. Ear and hearing problems have also been associated with increased contact with the justice system and have been associated with cognitive decline in older adults (He et al. 2019).

The ear and hearing health of First Nations people has steadily improved over the last 10 years due to new initiatives by government, Aboriginal Medical Services, non-government organisations, and specialist medical and paramedical groups, and researchers (Coates and Kong 2020).

Middle ear infection (otitis media)

Middle ear infection (otitis media) is a common disease in young children. Middle ear infections are preventable and treatable, but persistent middle ear infections that are not treated can cause lifelong hearing loss.

First Nations children, especially those living in remote areas, have high rates of severe, recurring and persistent middle ear infections and related hearing loss. Middle ear infections occur more often and start at a younger age in First Nations people compared to other Australians (Edwards & Moffat 2014; Gunasekera H. et al. 2009; Jervis-Bardy, Sanchez and Carney 2014; Kong & Coates 2009; Morris et al. 2005).

Different forms of otitis media

Otitis media refers to the inflammation and infection of the middle ear. The main forms of this disease are:

  • acute otitis media or ‘bulging eardrum’ – fluid behind the eardrum plus at least one of: 
    • bulging or red eardrum
    • recent discharge of pus
    • fever
    • ear pain or irritability 
  • otitis media with effusion or ‘glue ear’ – fluid behind the eardrum without acute symptoms other than conductive hearing loss
  • chronic suppurative otitis media with discharge (CSOM) or ‘runny ears’ – persistent ear discharge through a hole in the eardrum lasting for more than 2 weeks
  • dry perforation or inactive CSOM – a hole in the eardrum without evidence of discharge or fluid behind the ear (Leach et al. 2021).

Hearing loss

The ear condition that most commonly affects First Nations adults is hearing loss.

There are three types of hearing loss. The impact of hearing loss varies, depending on how severe the hearing loss is, whether it affects one or both ears, the type of hearing loss, whether the hearing loss is temporary or permanent, the person’s age when they first experienced hearing loss, and their access to services.

Conductive hearing loss is hearing loss that occurs when sounds cannot get through the outer and middle ear. Causes can include middle ear infection (otitis media), fluid in the middle ear, a build-up of wax in the outer ear or a hole in the eardrum. Conductive hearing loss may be temporary or permanent and often gets better without treatment but can usually be treated using medications, non-surgical procedures like ear cleaning, or surgical procedures such as an incision in the eardrum to drain fluid (myringotomy). Hearing aids can help those with conductive hearing loss.

Sensorineural hearing loss is permanent hearing loss that occurs due to damage to the inner ear, or when the hearing pathways to the brain do not function properly. In children, causes of sensorineural hearing loss include genetic factors, structural changes of the inner ear or nerves and infections during pregnancy. In older people, causes include ageing, exposure to loud noise, certain medicines, and exposure to certain chemicals.

Older adults are more likely to have sensorineural hearing loss. While it cannot be treated medically or surgically, hearing aids and cochlear implants can help those with sensorineural hearing loss.

Mixed hearing loss has elements of both conductive and sensorineural hearing loss.

Challenges with identifying ear and hearing conditions

Identifying and managing middle ear infection (otitis media) depends on children being referred to the services they need, at the right time and in the right place.

In young children, signs of otitis media may include the child pulling at their ears, fever, a complaint of ear pain, fluid draining from the ear or ears, dizziness or clumsiness, congestion related to a cold or a child being unusually grizzly and grumpy. In older children, signs of otitis media may include decreased alertness, asking people to repeat things, asking to turn sounds up, boredom, watching others for cues, poor concentration and behavioural problems (Schilder, Chonmaitree et al. 2016).

Middle ear infection can be difficult for parents and carers to recognise and for health professionals to diagnose. Children – especially very young children – can have otitis media with no symptoms or obvious signs. If there are symptoms, they are often similar to those of the common cold. Children may be uncooperative when having an ear examination, making diagnosis more difficult (Blomgren and Pitkäranta 2005; NACCHO and RACGP 2018).

This is why regular hearing checks starting at a young age, along with ‘opportunistic’ hearing checks – conducted when children visit a health service for any reason – are considered crucial to detecting and treating middle ear infection and preventing long-term hearing loss (Abbott, Frede et al. 2023, AIHW 2021). Effective health promotion and communication between carers and clinics have been identified as important for the timely detection of otitis media (Lau, Walker et al. 2024).

Among adults, hearing loss is often under-reported, especially when it is less severe. Under-reporting may be due to people not being aware that they have hearing loss or choosing not to report it (ABS 2020).


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