Ear Disease and Hearing Loss in Young Children in Niue: Connection, Communication, Community

Abstract

Background Hearing is a primary sense which facilitates the development of spoken language, social connection and an appreciation of sounds within the natural world. Hearing loss is a significant global public health problem and while Pacific Island countries bear the third greatest global burden of the condition, the relatively inconspicuous concept of hearing loss precipitates a dearth of useful country-based data that could be used to develop culturally appropriate interventions. The aim of this thesis is to determine the ear and hearing status of children five-years-of-ageand- under on the island of Niue and explore the knowledge, beliefs and practises of ear and hearing health of members of the Niuean community. Methods The thesis utilised three data collection methods, with each strand dealing with an important component to examine ear and hearing health in Niue. Population-based Study: Standard audiological testing procedures were used to determine the ear and hearing health status of all Niuean children 5-years-of-age-and-under. Qualitative Interviews: Twenty semi-structured interviews were conducted to understand the Niuean worldviews of ear and hearing health. Bilingual Survey: A descriptive survey was completed by 170 Niuean community members to identify factors associated with knowledge, perceptions and practises for ear and hearing health. Results The point prevalence of type Blow tympanograms indicative of otitis media with effusion by ears in Niuean children 5-years-and-under was 13.4%, 8.7% in children without external earcanal obstruction. Population prevalence within the sample was 19.5%, or 12.8% in children with a Blow tympanogram without external ear-canal obstruction. Point prevalence of hearing loss as defined as >25dBHL across three frequencies: 1000Hz, 2000Hz and 4000Hz was 12.66%. There was no significant gender or age effect (p>0.05). Wax occlusion was the main reason for failed otoscopy screening, with 95% of referrals being due to excessive or impacted cerumen. Significant associations were found between wax and male gender (p=0.029) and wax and older age groups (p=0.003). The general Niuean population have a good level of knowledge about ear disease and hearing health. There is high utilisation of free public health services at the local hospital and many members of the Niuean community use traditional and spiritual healing methods as a conjunct to hospital care. There is great potential for the implementation of improved ear and hearing health strategies including health promotion and education. Conclusion Niuean children aged 5-and-under have more favourable ear and hearing health outcomes compared to populations in other Pacific Island Countries and Territories and Pacific Island children, including Niuean children, in New Zealand. The proposed Lili Ear and Hearing Health Model can be used as an explanatory tool to shed light on the favourable hearing health outcomes of the Niuean paediatric population.