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

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 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.

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. For this reason, in Figure 1, progress for these measures is shown as ‘not assessed’. Within the context of the COVID-19 pandemic, it is even more difficult to assess trends. 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 hospital procedures and waiting times.

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).

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).