Ear and hearing health of Aboriginal and Torres Strait Islander people 2024

This is the third Australian Institute of Health and Welfare (AIHW) national report on the ear and hearing health of First Nations children and adults.

Some consistent themes have emerged from this reporting since it began.

Information on levels of ear disease and hearing loss is limited

Middle ear infection is a common and preventable childhood disease and is the main cause of ear and hearing problems in First Nations children. Middle ear infection tends to occur at a younger age and to be more severe and persistent among First Nations children than among non-Indigenous children. Chronic middle ear infections can lead to long-term hearing loss. Yet middle ear infections can be difficult for parents and carers to recognise and difficult for health professionals to diagnose, especially in very young children (Blomgren and Pitkäranta 2005, Mount Sinai 2024). 

Among First Nations adults, hearing loss is the main ear and hearing related condition. Hearing loss can also be difficult to recognise, especially when it is mild. People may be reluctant to acknowledge that they have hearing loss.

National health surveys of the First Nations population have largely relied on survey participants self-reporting these conditions or reporting them on behalf of young children. Reported measures like these are limited due to the nature of the hearing conditions. Comparison of reported hearing loss and measured hearing loss (based on a voluntary hearing test) has shown that hearing loss is substantially under-reported. These national surveys are conducted at long intervals (about 4 to 6-yearly). A hearing test included for the first time in the 2018–19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) was not repeated in the 2022–23 survey.

Recent trends have been impacted by the COVID-19 pandemic

During the COVID-19 pandemic, Australian governments placed restrictions on people’s movements and activities to prevent the disease from spreading. The impact of these restrictions – which also reduced rates of other diseases due to social isolation – shows up in various measures over time, such as the uptake of health checks, hospitalisation rates (although emergency department visits were less affected), use of audiology services, rates of elective hospitals procedures and waiting times.

It can be difficult to determine whether changes in rates of emergency department visits and hospital admissions represent a situation that is improving or getting worse. Increasing rates of hospitalisations may indicate either an increasing need for hospital services, or greater access to hospital services, or a combination of both. Within the context of the COVID-19 pandemic, it is even more difficult to assess whether recent increases in rates of emergency department visits and hospitalisations represent improvements or not. For this reason, in Figure 1, progress for these measures is shown as ‘not assessed’. 

Evidence of improvements

Reported long-term ear or hearing problems were becoming less prevalent among First Nations children, according to results of the 2018–19 National Aboriginal and Torres Strait Islander Health Survey. For First Nations children aged 0–14, the proportion reporting an ear or hearing problem decreased from 11% in 2001 to 6.9% in 2018–19. Results of the 2022–23 NATSIHS are scheduled for release in late 2024.

Australia has very high rates of newborn hearing screening and the uptake of health checks and audiology services is increasing again after declines recorded during the COVID-19 pandemic era.

• In Australia, very high proportions of First Nations and non-Indigenous babies have their hearing screened soon after birth – ranging from around 89% to 100% across states and territories with available data.
• In 2022–23, uptake of health checks among First Nations people rose to 27%, nearly returning to the level of 29% seen before the COVID-19 pandemic. The long-term trend of rising health check uptake among First Nations people was interrupted by a considerable pandemic-era fall.
• The rate of audiology service use among First Nations children aged 0–14 increased from 2021–22 to 2022–23, following large pandemic-era declines.
• Rates of middle ear related procedures for First Nations children aged 0–4 rose steeply in 2022–23, following steep pandemic-era declines.
• Median waiting time for myringoplasty surgery – a procedure to repair a hole in the eardrum – has decreased markedly for First Nations people following a large rise in 2020–21.
• In 2022–23, 62% of First Nations-specific primary health-care organisations (133 organisations) employed or had a visiting audiologist or audiometrist. This was more than double the proportion in 2013–14 (28% or 56 organisations).

Challenges remain

There is limited information about access to and waiting times for services, in the context of complex diagnosis and treatment pathways that people need to navigate.

While the primary care workforce is critical to delivering ear and hearing health services, it faces challenges including high staff turnover, competing demands from multiple programs and lack of training in ear health. These challenges affect the quality of ear health outreach in rural and remote communities and outcomes from it (Siggins Miller 2017).

A large proportion of First Nations people have measured hearing loss. There is also a high rate of under-reporting of hearing loss. People may not recognise that they, or their children, have hearing loss, or may choose not to report it in national health surveys. 

• The prevalence of hearing loss among First Nations people is high, with 43% of those aged 7 and over having measured hearing loss in one ear (20%) or both ears (23%) in 2018–19. 
• Among First Nations people assessed as having moderate to profound hearing loss, fewer than half (47%) reported having long-term hearing loss.
• Among First Nations women aged 20–39, rates of emergency department visits are nearly double those of men. In age groups within the 20–39 age range, the rate of ear or hearing related emergency department visits among First Nations women ranged from 11.1 to 12.9 per 1,000 population, compared with rates for First Nations men of 5.7 to 6.8 per 1,000 population.
• Hospital admissions for ear or hearing problems have increased sharply among young First Nations children, following pandemic-era declines.
• Median waiting time for myringotomy surgery for First Nations people increased between 2018–19 and 2022–23 (apart from a dip in 2019–20), after increasing steadily from 2015–16 to 2018–19. A myringotomy is a procedure used to treat ear infections that involves a surgical incision in the eardrum to relieve pressure or drain fluid, and may also involve the insertion of grommets, or drainage tubes, to keep ears free of fluid.

Data gaps and data development

There are some major data gaps in this area. In some cases, while some information is available there is a need for more complete or more frequent data. Information is needed on:

• prevalence of ear and hearing conditions
• patient pathways, including waiting times from initial screening to treatment and outcomes
• the ear and hearing health workforce, particularly outreach services provided by specialists and trained primary health-care workers
• ear and hearing health among incarcerated populations.

Progress is being made to fill data gaps through three key initiatives:

• a national Neonatal Hearing Screening Data Collection that will be a source of nationally consistent newborn screening data – an assessment of the feasibility of developing a national data collection was published in late 2023
• a new national Key Performance Indicator which will help to provide information on annual ear and hearing health checks for First Nations children in primary care settings
• The Australian National Child Hearing Health Outcomes Registry (ANCHOR) is seeking to compile a national research database to collate and track ear and hearing outcomes in Australian children.

More broadly, the National Health Data Hub (NHDH) is a national health data linkage system for health research and analysis. The NHDH will support longitudinal studies to support medical research, inform health services planning and policy development by government and non-government organisations, and monitoring of service delivery.

Figure 1: Changes in key measures of ear and hearing health for First Nations people