Patterns of persistent otitis media in the first year of life in aboriginal and non-aboriginal infants

Australian Aboriginal infants experience very early otitis media (OM). A previous study reported that OM with effusion (OME) or acute OM (AOM) was observed in the first 8 weeks of life in 95% of 22 Aboriginal infants, but that OME was seen in only 30% of 10 non-Aboriginal infants. Tympanic membrane perforation was reported for 1 Aboriginal subject at 8 weeks of age. This requires further investigation, because early OM onset has been demonstrated in non-Aboriginal groups to increase the risk of chronic and persistent ear disease in later childhood. This prospective study used otoscopy and tympanometry to describe the course of OM in infants examined repeatedly from soon after birth. Disease course was described in two ways, based upon earlier findings from other studies of Aboriginal schoolchildren. First, patterns of disease in the first year were identified; non-Aboriginal infants had occasional episodes of OME or AOM from which they recovered spontaneously, usually within 1 month; Aboriginal infants had persistent AOM, OME, or tympanic membrane perforation with discharge that rarely, if ever, resolved to normal. Second, conditional probabilities were calculated for ear state transitions at consecutive ear examinations, and a model of the course of OM was proposed for the Aboriginal infants. Results also suggested that binaural patterns of chronic OM described previously in Aboriginal schoolchildren may already be established in the first year of life. These findings will help service providers determine when to intervene to avoid the chronic consequences of early OM.