Almost all Aboriginal and Torres Strait Islander children living in remote areas have ear problems that start from within weeks of birth. For many, otitis media (‘glue ear’) leads to hearing loss and devastating learning and life outcomes.
Professor Amanda Leach, from the Menzies School of Health Research in the Northern Territory, has changed the fundamental understanding of the cause of ear disease and hearing loss, as well as how to prevent it.
This story is part of our 10 of the Best -Fifteenth edition. 10 of the Best is an annual NHMRC publication, showcasing 10 NHMRC-funded health and medical research projects. See more 10 of the Best.
The current median age for hearing aid fitting in Aboriginal and Torres Strait Islander children is around 5 years, with delays of up to 3 years due to requirements for particular diagnostics and referrals but limited availability of specialists.1
Profoundly shocked by what she saw as an early career researcher on the Tiwi Islands, Professor Leach, dedicated her life to making a difference to young kids.
‘On my first trip to the Tiwi Islands I saw that half the school children were wearing hearing aids. It was a phenomenal and distressing thing to see. I was so moved by those early trips,’ said Professor Leach.
Professor Leach was the first to discover that two types of bacteria, pneumococcus and non-typeable H. influenzae (NTHi), were to blame. But with over 90 different pneumococcal strains, which strains were the culprits? Why were the rates of ear disease so different among Aboriginal children in the Northern Territory compared to other parts of the world? Which vaccines could make a difference? Would the vaccine that combined NTHi-protein D be effective?
Professor Leach has systematically answered many of these fundamental questions and pushed further into public health interventions, including creating a free app for ear health support in remote areas.
‘The biggest challenge really is to wake Australia up to this issue. Ear disease is not a sexy disease so it keeps getting left behind,’ said Professor Leach.
‘But it can affect people through their whole life. Picture kids who can't talk, who can't communicate. There's poor bonding between mother and child. There's teasing at school. And in some cases, it leads to increased maltreatment because the kids can’t hear properly, that exacerbates frustrations in families.’
Her most recent NHMRC-funded project was VOICES: Vaccines to prevent Otitis media In Children Entering School. She conducted 2 randomised controlled trials of novel schedules that mixed licenced vaccines and led a team to develop national guidelines for prevention and treatment including antibiotic use.
‘The approach we took has opened people's eyes somewhat. I think this was one of the very first projects globally to combine different vaccines into a schedule,’ she said.
‘I feel very privileged as a scientist to be able to find solutions to problems and work with incredible collaborators,’ said Professor Leach.
‘I see both the big picture of this whole issue and then I see an important gap and say, “Let’s target that!”. So, I work to design a project around it and get funding and communicate the results. That is the real beauty of being a researcher.’
Next steps
The next step for Professor Leach is influencing primary healthcare. She’s training a specialised workforce of Aboriginal and Torres Strait Islander people in 20 communities. Importantly, by using their skills to identify likely hearing loss and sharing their knowledge in local language, the Ear Health Facilitators can immediately assist parents, teachers and the community to take action and better support children.
‘… there are so many barriers to prevention, including social determinants, quality healthcare, and a massive churn of health service staff that don't understand this issue,’ said Professor Leach.
‘They're dealing with acute care and very often, stressed. So, I thought, “What can I do about that?” We didn't want to drain health services. We want to create new skills, new jobs, and also address ear disease.’
CIA
Professor Amanda Leach
Team list
Professor Kim Mulholland
Professor Mathuram Santosham
Professor Peter S Morris
Dr Jemima Beissbarth
Ms Nicole Wilson
Ms Beth Arrowsmith
Institution
Menzies School of Health Research
Research title
Otitis media, hearing loss and school readiness of Indigenous children followed from birth in two randomised controlled trials of novel pneumococcal conjugate vaccine schedules (VOICES. Vaccines to prevent Otitis media In Children Entering School)
1Hearing Australia (2023). Annual Report 2022–23:COM088-Annual-Report-2022_23-Digital.pdf (hearing.com.au)