Ear and hearing health of Aboriginal and Torres Strait Islander people 2025

As part of the development of the foundational Ear and hearing health of Aboriginal and Torres Strait Islander people report, a range of data sources were reviewed and assessed for reporting. Data gaps and data development opportunities were also identified (AIHW 2022). The foundational report provided an overview of some key data gaps and development opportunities relating to prevalence, primary health-care data, nationally consistent newborn hearing screening, the ear and hearing health workforce, and outcomes.

Opportunities for data development include:

• Repeated measurement of ear and hearing health in national health surveys to increase the currently limited prevalence data
• regular reporting on key primary health-care indicators, including presentations and treatments for ear and hearing health
• a comprehensive standardised national neonatal hearing screening data collection, including pathways from screening, to diagnosis, to treatment
• drawing together information from existing school hearing screening programs and pathways from screening, to diagnosis, to treatment and outcomes
• expanded workforce data sources, with more detailed information on the ear and hearing health workforce, particularly on audiologists
• greater capacity to link administrative and other data sets to understand pathways and outcomes
• improved identification of Indigenous status in administrative data sets
• improved identification of people with ear disease and hearing loss in administrative data sets, particularly:
  • education and health data sets
  • data sets relating to incarcerated populations.

Some of the challenges that need to be overcome for improved data collection include:

• the fact that services involve many different health-care professionals, service providers and government programs. This creates complexity for:
  • extracting, collating and standardising data because services have differences in governance, funding, regulations, reporting requirements and information systems
  • creating data sharing arrangements, which may include a vast number of entities
• no consistent national classification system is used to code conditions and services
• key information, such as diagnosis, may be recorded in free-text fields, which makes data extraction and reporting difficult
• the lack of culturally appropriate, validated assessment tools to provide information on outcomes for developmental milestones, including language and speech.

This section provides an overview of important updates since the last publication. The data gaps and development opportunities discussed align with issues and priorities raised in:

• the Roadmap for Hearing Health
• national inquiries into the hearing health of Australians (House of Representatives Standing Committee on Health Aged Care and Sport 2017 and Senate Community Affairs References Committee 2010).

Prevalence of ear disease and hearing loss

The ABS National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) is the main source of data on the prevalence of ear disease and hearing loss among First Nations people. The large NATSIHS sample size, First Nations-specific survey design and repeated measurements over time allow for detailed examination of reported long-term ear and hearing problems. Reported long-term ear or hearing problems were included across the 2001, 2004–05, 2012–13, 2018–19 and 2022–23 surveys. 

The continued inclusion of a hearing test in the NATSIHS and a focus on how to better capture information on children aged under 7 is important for examining changes in hearing loss among First Nations people over time. Capturing this information for young children is critical as the key developmental period for language, vision, hearing and higher cognitive functioning occurs at this age. However, a hearing test was not included in the 2022–23 NATSIHS.

One main data gap relating to prevalence is the need for national information on how many people have ear and hearing conditions, such as otitis media. Research coming out of the Telethon Kids Institute will examine the feasibility and effectiveness of ear health screening from 6 to 8 weeks of age. The project will follow a cohort of over 600 children and provide prevalence estimates for otitis media and hearing loss in First Nations children aged 0 to 5. Collecting information on recent experiences of ear disease and hearing loss, particularly for young children, would greatly improve data on prevalence.

As well as NATSIHS, including ear and hearing health related questions in other national surveys would increase available information on the prevalence of ear and hearing problems. Results from the Australian Eye and Ear Health Survey conducted over 2022-2025 are presented in this report for the first time. 

Primary care

High quality information on primary health care is essential for understanding the role and use of primary care in the diagnosis, treatment and management of ear disease and hearing loss among First Nations people.

Information about how people use primary health care is limited. The Australian Institute of Health and Welfare (AIHW) is involved in the following activities to improve the quality of information on primary health care.

The AIHW is leading work to develop nationally consistent primary health care data.

The AIHW is working in partnership with the Department of Health and Ageing, and the Australian Digital Health Agency to develop and implement a framework to guide the use of My Health Record system data for research and public health purposes.

The AIHW is developing a new indicator on annual ear health checks in primary care settings:

This indicator is important because frequent assessment of ear and hearing health ensures early identification, management and treatment of ear disease and hearing loss. Reporting this information will improve understanding of service coverage and service access, and will inform decisions about providing services to areas most in need.

The new indicator would be collected as part of the national Key Performance Indicators (nKPI) collection, which is a set of primary health care indicators for First Nations people focusing on maternal and child health, preventative health, and chronic disease management. The collection contains data on First Nations regular clients of organisations receiving funding under the Indigenous Australians’ Health Programme.

The indicator is being pilot-tested for a few collection periods starting from June 2024 to assess data quality. The indicator will be considered for inclusion in the data collection depending on the results of the pilot testing.

Newborn hearing screening

States and territories collect data on their respective newborn hearing screening programs. However, the content and scope of data collected varies. Substantial efforts have been made to adopt more consistent and comparable indicators across neonatal hearing screening programs nationally.

An Australian national data collection for newborn hearing screening would improve the availability and quality of data. Such data would support nationally and internationally consistent measurement, reporting, and standards for evaluating programs and outcomes.  

The AIHW has been working collaboratively with Commonwealth and state and territory governments on newborn hearing screening data development since 2013. In 2023–24 the Department of Health, Disability and Ageing engaged the AIHW to work with jurisdictions to develop a set of standardised data items that could be collected to support national reporting. A report summarising the next steps in developing a national newborn hearing screening data set was released in July 2025. An updated National Framework for Newborn hearing Screening was also published by Health in July 2025. 

The AIHW has been engaged by the Department of Health, Disability and Ageing until 30 September 2027 to work with jurisdictions to further progress national data development for newborn hearing screening. 

The AIHW recommenced work in September 2025 and will continue to progress the workplan over the next 2 years. The current workplan includes the development of nationally agreed data items, definitions and specifications to support reporting on audiological assessment, diagnosis and intervention.

Ear and hearing health workforce

The workforce delivering ear and hearing health services is dynamic (high turnover) and diverse. It includes both specialists and generalists with ear and hearing health capability, and models of care can vary between services and regions. Available ear and hearing health workforce data give a broad indication of access to specialists and ear and hearing health services. However, current data provide an incomplete picture. The extent to which First Nations patients are serviced by ear and hearing health professionals is not clear from audiology, ENT or allied health personnel data.

Possible data developments that would increase understanding of the ear and hearing health workforce include:

• adding audiologists to the National Registration and Accreditation Scheme
• developing a national register and nationally consistent workforce survey for all allied health disciplines. For more information, see Allied health workforce data gap analysis – issues paper | Department of Health, Disability and Ageing.

Outcome measures

No national data sources provide insights into health or social outcomes among First Nations people with ear disease and hearing loss. Two main approaches could be used to examine outcomes of First Nations people who have experienced ear or hearing problems:

• targeted longitudinal studies
• data linkage of health and outcome-related data sets.

Targeted longitudinal studies

National Acoustics Laboratories is developing a longitudinal study called HearOut, focusing on hearing health outcomes for First Nations children. A First Nations leadership group has been established to provide cultural guidance and advice around culturally safe research practices. The project seeks to define and understand relevant developmental and wellbeing outcomes, and what tools/ resources are available to inform a longitudinal study design.

The project conducted a literature review which revealed a substantial knowledge gap on the negative impacts of persistent otitis media in early childhood on speech and language for First Nations children. The National Acoustics Laboratories report that many of the studies reviewed assume that developmental milestones for First Nations children are the same as they are for non‑Indigenous children, and use standardised assessments with little to no adaptation. In the published literature, only 4 development-related checklists were found that have been adapted specifically for First Nations children. As well, very few Health-Related Quality of Life tools have been developed or adapted for First Nations populations. Ethics applications are underway, and they are in the early stage of establishing research agreements with participating communities.

The Study of Environment on Aboriginal Resilience and Child Health (SEARCH) has followed over 1,600 First Nations children in urban and regional New South Wales since 2008 to provide longitudinal information about their health, including hearing and speech development. The SEARCH is owned and led by First Nations people. It functions as a long‑term partnership between the Aboriginal Health & Medical Research Council, Aboriginal Community Controlled Health Services in New South Wales, the Sax Institute, and researchers from across Australia (Sax Institute 2023). Longitudinal analysis of this data source has the potential to provide new insights in antecedents of ear and hearing related outcomes.

The Djaalinj Waakinj cohort study (Swift et al. 2020) investigated the early onset of middle ear infection (otitis media) among Aboriginal infants in an urban West Australia setting, finding that the condition begins early in life and persists throughout infancy for many children. Among 125 infants enrolled:

• one-third had middle ear infection at 2-months, rising to nearly half by 6 and 12-months (Richmond et al., 2023) 
• 45% of infants had hearing loss (≥ 25 dB HL) at around 12-months (Veselinović et al. 2023). 
• Infants with middle ear infection detected before six months were over three times more likely to continue to have disease at 12-months than those without early onset. 

These findings highlighted that middle ear infection is not confined to remote communities but also in urban areas. Subsequently, routine ear-health screening with otoscopy and tympanometry for First Nations children is being implemented across WA (at ages 2, 4, 12 and 24 months, plus school entry hearing screening), administered through the Child and Adolescent Health Service (CAHS) in metropolitan areas and the Western Australian Country Health Service (WACHS) in regional and remote communities (CAHS, 2024).

Data linkage of health and outcome-related data sets

Data linkage (also called data matching, data integration or record matching) combines information from multiple data sources while preserving privacy. This tells a much more powerful story than is possible from individual data sources in isolation. It can also improve understanding of a range of issues. However, capacity to examine outcomes using data linkage is limited by data gaps in information on First Nations people with ear disease or hearing loss in administrative data sets.

The Murdoch Children’s Research Institute has been funded to develop the Australian National Child Hearing Health Outcomes Registry (ANCHOR), which seeks to compile a national research database to collate and track ear and hearing outcome measures. The program will pilot hearing-specific service data collections from Victoria and Queensland with an access and equity lens ‘to ensure no deaf or hard of hearing (DHH) child “slips through the cracks’” (MCRI 2023).

ANCHOR also aims to develop a national Core Outcome Set to enable services and researchers to measure outcomes that are important to deaf and hard of hearing children, families, and services. The National Acoustic Laboratories HearOut study has been exploring what outcomes matter to Aboriginal and/or Torres Strait Islander communities who experience recurrent and persistent otitis media. ANCHOR is exploring what outcomes matter to Aboriginal and/or Torres Strait Islander children who are born with permanent sensorineural hearing loss. Together, this information will facilitate streamlined data collection that can be used to identify service gaps and areas of need.

Data linkage would allow research on the relationship between ear and hearing health problems in childhood and outcomes such as contact with the criminal justice system

The patient journey

The ear and hearing health service system is complex, and navigating it is challenging for patients and their families (the patient journey). There are critical points in this patient journey where delays to receiving care, and burden in accessing care, may result in patients ‘falling out’ along the care pathway.

There are no national sources of data on how many patients are lost along this patient journey, at what stages, or for what reasons.

Access and experience

Researchers from Flinders University are undertaking the Pathways For Aboriginal and Torres Strait Islander Hearing Health: The PATHWAY Project (Flinders University 2022). The aim of this project is to identify the current hearing health-care pathway patterns for First Nations children, from surveillance, through management and follow-up. Located in South Australia, the project is co-designed in partnership with Aboriginal communities, to help overcome difficulties experienced by First Nations children in accessing hearing health care.

Early consultation shows that there are a number of points along the pathway where children are ‘falling out’ of the system and not getting the help they need. The study will take place over 18 months and will be conducted through a yarning based intervention to further understand lived experience. The project will focus on building local capacity, to train Aboriginal health workers and support them to continue ear health work in between fly-in-fly-out visits from other professionals.

The PATHWAY Project also involves a local ‘Patient Navigator’ role to help families identify and access the relevant support services for their child’s ear health.

The hidden wait list

The waiting time for elective surgery is an indication of how easy the service is to access.  Information about waiting times for elective surgery presented in this report refers to the time a patient waits for elective surgery, calculated from the date a patient is placed on the hospital’s waiting list to the date of admission for the surgery. However, this does not include the time taken at other steps in the clinical pathway. These steps include accessing primary health care, the process of health professionals diagnosing the underlying condition and referring the patient to an ENT specialist, obtaining appointments with an ENT, and being placed on the surgical waiting list.

The additional time between referral from primary health care to initial consultation with a medical specialist such as an ENT, sometimes referred to as the hidden wait list, is an important step in the patient journey but is not well understood at the national level. National data are available in the National Non Admitted Patient Data Collection. However, further investigation is required in collaboration with states and territories to determine whether data quality and reliability are suitable to meaningfully report on outpatient waiting times.