Up to nine in every 10 Aboriginal children in some remote Northern Territory communities have a hearing impairment, but a new project aims to tackle that by training locals and reducing fly-in-fly-out (FIFO) specialists.
Researchers have long observed the negative impacts of otitis media, or "glue ear", on children's education, childhood development and social outcomes, and say it needs to be detected far earlier.
"If I'm actually doing surgery on these kids, we've missed the boat," Kelvin Kong said.
Dr Kong is an ear, nose and throat surgeon who will be one of the leaders of the new initiative, delivered by Charles Darwin University (CDU).
The $7.9 million five-year program is funded jointly by the NT and Federal Governments and philanthropic venture the Balnaves Foundation.
It will attempt to reduce the need for FIFO specialists by training and employing local community members as support workers who can recognise the symptoms of glue ear, assist with the diagnosis process and help families treat and manage infections.
Amanda Leach from the Menzies School of Health Research will lead the project with Dr Kong, and said that while a lot of evidence had been collected about the best way to treat ear infections, implementation was where children fell through the cracks.
"We think this program will provide a culturally safe and appropriate long-term service every day," Professor Leach said.
"Our goal is that every ear of every child is hearing normally every day; that's just not happening at the moment.
"Only around 10 per cent of children have bilaterally normal ears in their preschool ears. 10 per cent is not good enough."
Communities will be asked for input about how the program should be rolled out and which community members should be involved.
"[The ultimate aim] is that we don't have a role in this because it's actually run by the community, they can identify the problems and they can navigate the health system and get the help they need to," Dr Kong said.
"It's all about Aboriginal governance which will have the leadership in this."
Hopes for combating jail over-representation
Dr Kong was Australia's first Indigenous ear, nose and throat surgeon, in a Western sense — he points to Aboriginal Ngangkari healers who would perform some procedures as his forebears.
He said the long-term impacts on children with hearing impairments could be profound.
"If this is your child and they're not speaking for two years, that's a huge impact on interactions, on smiling, on story time, on cultural passing down, dancing, on singing," he said.
Professor Leach said six months was too long for children to wait for an audiologist to fly in to their community.
"That's too long to wait when these children are going through their rapid brain development, language skills, and you just see that they're not progressing in their development," she said.
NT Health Minister Natasha Fyles said the need in the Northern Territory warranted a significant investment, noting that children's experience in the classroom informed the rest of their lives.
She said that Aboriginal Territorians were grossly over-represented in jails.
"This [program] is generational change," she said.
"This will mean the next generation of Territory kids won't be dealing with their hearing loss later in life, that has the social impacts that cross across government agencies and community."
The partnership was an exciting opportunity to fight preventable hearing loss among current and future generations, federal Indigenous Health Minister Ken Wyatt said.
"Lifting the capacity of local families to recognise, report, and treat ear problems early promises to help our children reach their full potential," he said.
The number of Indigenous children affected by glue ear was "not fair and it's certainly unequal," CDU chancellor and founder of the Balnaves Foundation Neil Balnaves said.
"The amount of children affected by it would be regarded in any other place in the world as an epidemic, and it's got to stop," he said.
Children with glue ear struggle with education
Ear health specialists from around the country and overseas have gathered in Darwin this week for a biannual conference on otitis media.
On Tuesday, child development expert Steven Guthridge from the Menzies School of Health Research presented findings from a study funded by the Prime Minister's Office and Cabinet, confirming a long-suspected link between otitis media infections and poor educational outcomes.
The study used data on Aboriginal children in years one and three in the Northern Territory and measured school attendance and school performance.
"Across all our measures, hearing impairment has significant impact … to the extent that those children with hearing loss will have something in the order of one-and-a-half to twice the risk of not being ready for school or not performing to the national standard," Professor Guthridge said.
"It's been widely recognised but this actually demonstrates that association and actually quantifies the extent of it."
The data gathered will also be used to evaluate the effectiveness of new programs to combat the issue.