TRUDY: Hello, and welcome. On behalf of the RIDBC ......and share my personal involvement from being...

2016-04-06 11.59 HOPE Donna Rees

Suite 43, Cleveland House, Cleveland 4163 PO Box 265

Cleveland, QLD Australia 4163

Phone +61 7 3286 3901

http://bradleyreporting.com ABN 71908 010 981

Subtitled transcript link: https://youtu.be/KZTEN7HTktg

TRUDY: Hello, and welcome. On behalf of the RIDBC Renwick Centre and

Cochlear Limited, it gives me pleasure to welcome you all here today to the

first of our 2016 Hope lectures. We are in for a really fantastic session. I hope

you enjoy it.

We have Donna Rees presenting for us today. Donna is Assistant Principal,

hearing, based in Dubbo in Western New South Wales. She is also the

Treasurer of the National Association for Australian Teachers of the Deaf and

the New South Wales branch of the association as well. She is a busy lady. I

think what makes Donna so interesting as a presenter is that she is the parent

of a child with hearing loss as well, so she brings a really unique perspective to

the presentation. I know we are looking forward to it.

I will get through a couple of housekeeping things before I hand over.

This session is endorsed by the AG Bell Academy and BOSTES, so please

send through your details after the session so we can update the two sites and

let them know you attended this session. It is being recorded and you will be

sent the link to the captioned recording. We have Roxanne from Bradley

Reporting joining us today. We appreciate their ongoing support.

If you want to see the captions larger or smaller, you have the capacity to

make the window bigger. Have a play with that and get that to your comfort

level. As I said in the warm-up, we would like to keep this a nice clean

recording. If you have questions or you would like to clarify a term, just use the

chat function and I will interrupt Donna and clarify that term. If you have a

question, I will hold them till the end of the session. This is a one-hour lecture.

http://bradleyreporting.com/

https://youtu.be/KZTEN7HTktg


I will hand over to Donna. Go ahead.

DONNA: Thank you, Trudy. Welcome, everyone.

This presentation, addressing the implications of Otitis Media on a student’s

education, health and general wellbeing, is quite broad and somewhat

presumptuous given the complexities. However, my aim here is to unpack it

and share my personal involvement from being an active teacher of the deaf

with otitis media caseload, a parent of a hard of hearing child and a volunteer

in the project mentioned.

When I refer to a student, I am talking about all ages, including infants through

to high school age students. My personal involvement has literally placed me

into the situations where I have seen firsthand the real struggles of children

with hearing loss and ear health issues of all ages across all sectors and in all

areas of health, education and wellbeing. So here we go.

We have this word 'implications'. I can't assume knowledge and understanding

on your behalf so it is going to be a matter of what your current knowledge and

experience is as to how deep your understanding and what you take from this

presentation today.

I've deliberately pulled back some of the jargon, acronyms, and what I assume

your level of knowledge to be, and so for some what I have to show is not new;

for others I am hoping to increase your awareness and understanding across

quite a diverse range of issues associated with my topic, addressing the

implications.

Here we go.

As a teacher of the deaf, my observations of children struggling in their

learning environments with hearing loss, speech, language, communication,

social and emotional issues due to otitis media are seriously concerning. The

combined issues continue to affect too many children, countless of whom don’t

have a diagnosis, are unsupported with medical, educational, technological


interventions and have parents, carers, and teachers who are generally

unaware of the implications associated with hearing loss.

…

This point in itself leads to opinions and hearsay when things are not quite how

we think they should be.

The situation is, though, at least in education, there is very clear evidence in

our infants, preschoolers, right through to high school where the gaps for these

children have just grown larger and thus the roll-on effect continues to stand

out as a problem. Suspensions, behaviour, poor access, academic results are

low. Incarceration with juvenile justice are just some of the wider ranging

implications we are seeing.

Otitis media as a health condition can be diagnosed as various types and

degrees. These range from otitis media with effusion, commonly known as glue

ear the most common, with less obvious physical symptoms, to the more

obvious and serious chronic suppurative otitis media with a smelly puss-filled

ears leaking on a burst eardrum. Both lead to varying concerns in themselves,

but generally the resultant hearing loss is the hidden issue.

So here we have kids in our classes expected to be listening for up to 70 per

cent of the day who just simply can’t. They don't tell us. We don't have the gift

of knowing who has the issues on any given day; it fluctuates. If we did, the

child's ear health would be checked, hearing levels would be measured and we

would have a start point. We could find substantial hearing loss issues. But,

sorry, this isn't the norm and so it is yet another piece of the puzzle or barrier to

navigate.

'Excuse me, Mrs Rees, I’ve got glue ear today. Can you adjust your teaching

strategies for me?’

We know that in an educational setting if it is hard to hear, then it is also hard


to learn. In the area of health and a child's personal wellbeing the issues are

huge.

There are simply too many gaps in our current service provisions and

pathways for support. Do we even know how to start with some of these

pathways for with the complexities some of these children present with?

Knowing they have a loss could be one part of this but certainly it is not all.

Education. It is easy to state the obvious. Aspects such as participation,

attendance, learning, attention, behaviour, social skills, mental health, listening,

auditory processing, technology support, speech and language skills of the

individual child can all be linked to otitis media. It really does all come back to

education as a generalised factor. But there are so many aspects to be linked

to awareness and knowing the combined health, education and wellbeing

implications of this condition, which need greater attention. How deep is our

knowledge? Do we even know what we don't know?

This is relevant for everyone as it really is everyone's business. Visiting the

information over and over and gaining deeper understanding is important.

ENTs knowing education and wellbeing implications could be very important

too. Did you know that to learn a new concept a child needs around 12

exposures to it, but for hard of hearing children it is at least double that.

Yes, I have a strong personal interest in this area. I've lived through the

complexities of diagnosis, treatment and ongoing technological inventions and

wellbeing issues for years with my own children and now grandchildren. I work

amongst children with the issues, and the teachers who deal with the

ramifications every day, and volunteer to support it at my work day's end.

Through this personal ongoing experience, continued learning and inquiry,

research and having opportunities to attend many recent national conferences

regarding the best practice for health aspects of otitis media, I should have a

pretty good idea of the situation. The content of the conferences has been


interesting, and for one you might get the impression that Australia and New

South Wales are doing okay in this area with some aspects but, sorry, these

conferences don't reflect enough of the real issues. Not as we see them,

anyway.

We as educators get to see the day-to-day life complexities that otitis media is

causing these kids. The assessments, surveys, criterias, audiological results

don't always demonstrate reality. We are only getting a snapshot on the day

with the ear health and the audiology. Observations, though ... deficits not only

in black-and-white data scores but in a more realistic degree.

We see the struggles these children face first-hand. It’s not only the day to day

in the classroom but across all the areas mentioned. And it is evident in all

children of all ages across all sectors.

We are dealing with the whole child here. His overall health, nutrition, living

environment, family, care, shelter and attitudes of all those who care for him.

Who is looking out for him?

From a medical perspective, yes, there are well researched pathways to follow

for treatment. However, without support many children simply aren't on these

pathways and are not getting to the doctor let alone a specialist.

For many families the whole situation is very hard to navigate and manage.

They aren't on any pathway to having better ear health or hearing let alone

access to education and improved wellbeing, because for any number of

reasons we failed them and they have slipped through the net.

Comprehensive support for these children is scarce. Gaps and lack of service

provision and good follow-up have just grown larger and thus the roll-on effect

across the child's life continues to stand out as a real problem. These kids are

in our schools or maybe they are not.


Prevention and awareness programs are about and they are well funded.

Diagnosis is possible. Treatment is possible. Support is possible. Changing

the prospects of a child's life is possible. But the reality again is we have wait-

lists, lack of staff, distance, low follow-up and revisit rates, and a severe lack of

funding.

An audiogram sent home in a child’s schoolbag just is not enough. Do the

parents and carers understand the diagnosis? … that are seen most where

support is needed right back at the get-go of education around what, why and

how we can manage this multifaceted situation.

One visit to the GP without a tracking of history doesn't provide the GP with

enough info to act on.

Lack of supportive evidence at the ENT appointment won't get treatment

sooner. Lack of evidence specialist teachers any sooner. So we are in this

struggle. We need solutions that work for a long time. More than in my 20-

year involvement.

We know why, but have we worked out what is needed, how will it work? Who

needs to be involved? Conversations, reviews, wading through policies and

research – it has all been a work in progress with many opinions, rules and

regulations to get through the initial gateway. But even once through, there

have been mazes and brick walls for Hear Our Heart Ear Bus Project and the

dream to provide a possible solution. What is this project all about?

Who are the people behind the project and who are the partners who help

them to achieve the plan? It is for all kids from any school. Non-age – so it is

not just with the four-year-olds.

A specific strategy. Let's fast forward. What is the plan? Does this plan cover

all aspects we are concerned with? What is comprehensive? Is it localised?

The project strategic plan has 10 key elements that address these areas. For

the benefit of flow in this presentation I have now separated these areas.

However, in reality there may in fact be many strategies in play at any one time


to ensure the whole situation is well managed.

So, let's start with the education setting in regard to what research and

observations are telling us.

Kids with hearing loss may have poor educational outcomes with low literacy

scores. They may have poor speech and spoken language, poor

comprehension, receptive skills, poor auditory memory, poor attendance. They

drop out of school earlier. Behaviour is notable, and poor attention.

Another big one is reduced IQ scores, with misdiagnosis due to the language

deficit caused by the hearing loss. Not looking good for them, is it? Will they

ever catch up?

To address some of these issues in education, the strategies have been

working with these areas with very positive outcomes. Education settings are

supported with professional development for staff. This support has a focus on

the implications on a student's access and participation especially in the areas

of education, listening, speech, language development, behavior and

wellbeing.

It is all about helping staff who are already really busy understand that their

students may have issues due to hearing with development in key areas and

by knowing the students’ hearing related situation it will help the children reach

their potential.

Knowledge of resources such as the Cochlear Integrated Scales that provide

comprehensive development steps and the early learning framework are great

resources especially for educators around 0-6, and can help put this into

context.

Teachers are guided through survey checklists that look at areas that may

suggest the student could be having a hearing loss. These are statements to


consider regarding behaviour, learning, speech and physical identifiers.

Just as differentiation to content and methods are workshopped … making it

real, visual and as it sounds with earplugs and scenarios, and this is gold. The

focus is that many alterations, inclusions to strategies could be relevant for

many other students as well. The message being that by taking a step back

and really thinking about the students and realising the new strategies are not

extras but can be inclusive in the quality teaching that has already exercised.

This professional support is scheduled both prior to screening and post

screening. The pre-screen information helps determine the students to be

tested and then as a follow-up discussions about the results are had, making

the meeting very relevant for each teacher about each student as it is matched

with a comprehensive report detailing findings from screen tests and advice to

follow up.

Healthy Ears Better Listening programs are for all ages, focusing on prevention

and awareness, including the breath low, cough, wash and chew strategy, how

the ear works, what we can and can't hear with hearing loss. Lessons are

structured to suit ages. The puppets Snotty Sam and Lucy are totally involved

and even have sleepovers, taking with them their logbooks for class letters

about the Healthy Ear experiences. … prevention and awareness including

noise-induced hearing loss. We should be protecting our ears and all the dos

and don'ts, as promoted in the support materials such as the New South Wales

Healthy Middle Ears, federal government Care For Kids Ears, Kelvin Kong’s

team with L'il Mike, World Health Organisation, the Snot Song and other

programs.

Support and advice is provided around sound … application, what strategies

might help in the classroom, and getting the staff to really think about acoustic

management of the learning environments.


Listening, auditory skills, language support is offered with the Department of

Education partnership. Professional development is provided to staff by

specialised experienced teachers of the deaf working in the area of conductive

hearing loss.

School support may also include looking at those students who had a

diagnosis and may meet criteria for additional support such as the itinerant

support teacher, hearing, also with the Department of Education.

It has been interesting watching colleagues in recent times as the project along

with key partners has gently infiltrated into several schools. The positive

testimonies have been overwhelming. It is very rewarding to be a part of this

program that has really made and continues to make a difference to so many

children and their families.

We do though as educators have policies, plans and standards that spell out

for us our expectations such as the Code of Conduct and Disability Standards

and Child and Wellbeing. There have been times that some educators have

shown some reluctance to wearing the FM or soundfield, altering seating

plans, or including the nose-blowing in the daily routine.

My message to them is clear and simple: do you know your students?

Standard 1.

These daily inclusions are about them, not really you. There would also be a

breach of disability in regard to the FM there.

Moving along. Education as you see it is huge but so is health. It is another

minefield. Take a look at what the plan has included for health and clinical

aspects. We have the hearing screening component, Step Into Play, here with

the targeted group of students from the teacher survey and/or referral for other

reasons. Some think this is it; this is all the project does. Sorry, but it can't


start or stop there. Procedures for audio staff are all in place so audios know

the program and protocols and referral procedures. All ages are able to have

screening with ear health checks for those not up to the behaviour response.

Diagnostic ... younger or more difficult children or in some cases to

double-check findings. The screen also comprises the otoscope to view the

ear canal and ear drum, tympanometry to measure pressure in the middle ear,

and audiology to measure what is heard.

The otoscope can also provide photo-imagery for records to be sent directly to

the ENT if required. This is also useful with parents and teachers as a teaching

tool to help with the conversations when unpacking results.

Again, visuals are gold. It is all helping to build greater understanding beyond

the paper result. Parent-friendly student reports are sent home with the audio

results. This is a comprehensive visual explanation of the process of the

hearing screen, and the support pathways arranged.

Direct conversations between the parent, carer and audiologist/audiometrist is

possible if required, but … results are also common.

Parent meetings post screen with specialised teachers of the deaf and/or

health education support worker is available if needed or requested, and

comprehensive start reports, as mentioned previously, are provided and again

are linked with the meetings with the school learning and support staff.

If a screen shows issues in the audiometry component, booth testing is

arranged with full further diagnostics beyond the screen. Australian Hearing

referral may also be needed. GP and ENT referrals are made and followed up

with parents.

The ENT appointments are supported with Department of Ed itinerant support

teachers, along with the history of all screens and booth results on hand.


Outcomes for any surgery is explained and assistance with documentation

offered.

Many of our families are not confident in asking for this support. This is

provided with the intention of building their confidence and understanding their

role in continuing care.

After leaving a school, the project then revisits after a scheduled three months.

Wellbeing. This area unfortunately is often overlooked. However, it is essential

in understanding and supporting the whole child. Hearing related mental

health issues are recognised widely, but like many issues in this area are at

times overlooked or misinterpreted as being something else. Ignorant,

naughty, not willing to engage, moody, loner, to name a few. Support is crucial

to help move our students through the issues that are likely to resurface

throughout the milestones of their lives.

Diagnosis of hearing loss for all involved, especially parents of the young, can

be very upsetting. As the young child then weaves through the webs of

treatment, technology and holistic development with the obstacle of hearing

loss, there can be real grief. Coping with all of this is difficult.

I am personally happy to see New South Wales 2015 Supported Students

Successful Students initiative. Schools are being supported around wellbeing

services that best meet the students’ needs. Supporting the most vulnerable.

Our kids fit this.

All community members, including educators, share the responsibility to

provide for our children. The wellbeing framework offers context for schools,

the local communities, to enable students to connect, succeed and thrive at the

stage of their development and learning. Students need personalised support

that is relevant to their specific needs… a range of issues of the hard of

hearing children … they bring to the table. Understanding of what their hearing


issues can mean to each of them personally is a start. Helping them become

resilient, independent young adults with bright futures is something we can all

be part of.

A researcher I have personally been following for years, Damien Howard, has

really dug deep to unearth some real life stories and his work is really worth

taking a look at.

There we have most of the strategy, but there is still a fair way to go. We have

some interesting stats coming through from a wide range of children, some

unexpected surprises, some shocking, distressing stories too, but we as a

team in partnerships are making a positive difference.

Our findings to date include visiting over 20 preschool and school sites with

over 2,500 students having their first hearing screen. The rate of follow-up is

currently at 40 per cent of those screens.

We have the typical ear health issues that are very common with the type B

fluid behind the eardrum and type C tympanometry -- type C being Eustachian

tube dysfunction, where nose blowing can assist. We have perforations,

scarring but we have also had too many of the chronic suppurative, with the

leaking otitis media serious conditions, as well as some sensorineural hearing

losses. The ENT program linked to the initiative as a partner has seen over

250 children all referred after a wait-see approach of three months with no

change. There have been over 120 surgeries varying again from simple

grommets to the more complex grafting to repair eardrums and ear bones.

Australian Hearing has also been involved, with over 25 children being referred

with complex issues, and four of them now being ... a lot of these students

have either had sensorineural permanent hearing loss, mixed hearing loss or a

permanent conductive loss due to the ear disease of otitis media.


Working closely with communities over a long period of time has given me an

insight as to what they do or don't like and want. They are very clear in telling

us that the band-aid solutions don't work. The seagull analogy of flying in,

doing our business and flying out was a great one I had heard directly from an

elder at a state political discussion. Communities don't like this, either.

Separate agencies ticking off boxes is tricky. There are so many non-

government organisations around these days, many of who are unaware of

what each other offers.

I like the attitude of Mooney Park(?) in New South Wales, who ask non-

government organisations to provide them with their information about what

they plan for the community, and then wait to be invited. This stops

duplication, which is no good to anyone.

Having said that, this project needs partners. Schools need the partnerships

as well. They need agencies with expertise. The partnerships though really do

need to be relevant to be effective. The attitude of ‘my way’ may not be the

best. For a program to be really truly comprehensive all parts need to be

pulled together so that at the end of the day no aspect of the child's situation is

falling through the gaps.

We are all in this together and need to be fully cooperative, consultative and

open-minded with knowledge reciprocated between the stakeholders.

Anyone working out in the communities needs to demonstrate the sensitivity to

culture and a safe environment for these children. We often see a reluctance

to travel out of these communities by some families for many reasons, and

some of them are simply because of insecurity and feeling vulnerable outside

their own familiar environment. It makes sense to go out to them as much as

the project allows.

The success of this program has been through hard work and a never-give-up


attitude. It has been consultative from the get-go. We as a team with partners

have reviewed, changed things again and again to meet the local needs. The

plan has looked different for different schools and communities. We have

opened a can of worms, and the issues are huge as you may now see. But this

is our children and future generations.

Otitis media affects all children, it is not selective. But we know it may have

long-term implications across many aspects of our kids’ lives. For these

reasons, otitis media should be everyone's business.

We are determined to make a difference for them. So, as a team, we are off

the roundabout, even though it does pop up to confront us now and then. The

ideals of this project can be duplicated anywhere. Here we are spreading the

word, with an emphasis, though, on any strategy for ear health and hearing

really needing to be inclusive and providing the much-needed support in all

areas.

If you are keen to make a difference in the kids' lives, given the obstacles, don't

be a bystander. Take up the role of the lifeguard and wear the armband. Don't

be the person who wondered why someone didn't do someone for that boy's

ears.

As a nonprofit charity without government funding every little bit helps. The

project is always seeking advice and is appreciative for all assistance with in-

kind support and funding. Volunteer audiologists have come from all over the

eastern states, and here is another call-out for more.

There has been fantastic in-kind financial and professional support from local

and national experts in similar successful programs -- doctors, ENT surgeons,

schools, community groups, health and non-government organisation

partnerships, media and corporate sponsors. They are all actively supporting

the program and keen for it to continue with a custom fitted bus to be included


in the near future.

We can't forget our local committees across the local towns. No job is too

small and there are plenty of them. Here are a few pics of them. They are all

still smiling.

I will leave you with some useful links and references. I hope you have

enjoyed this presentation. Please feel free to contact me if you want some

clarification on any of the areas spoken about. Within the links we have one

very useful one as the earinfonet. The L'il Mike is a YouTube about a little guy

experiencing ear health issues that has been put together by Professor Kelvin

Kong, in New South Wales, Care For Kids Ears, a federal program. Ear

Troubles, based in the Northern Territory with Damien Howard being at the

forefront of that one. Sammi Fatnowna and her husband, Garth, have

produced some great resources, one of them being the Snot Song.

Deadly Ears Queensland have fantastic programs again that are very

successful. The World Health Organisation has some really relevant resources

particularly around noise induced hearing loss. The Integrated Scales for

Development from Cochlear I find really useful, particularly when speaking to

preschools and the early learning sector. We have the recommendations for

clinical guidelines on the management of otitis media, which has a really strong

health focus, but again really good for people to see visuals and understand

the health related pathways.

Australian Hearing, of course, again with the conductive hearing loss have very

comprehensive information on the websites, and the Australian Hearing offices

in a lot of areas around Australia are again really useful.

Royal Institute for Deaf and Blind have an outreach program that we are in

partnership with. Again, really appreciate the ongoing support with the team at

the Royal Institute for the Deaf and Blind. You may recognise some photos


there.

The New South Wales Department of Education hearing support team -- we

have positions in New South Wales where conductive hearing loss is a focus.

The Aboriginal and Torres Strait Islander Ear Health Manual -- I have a picture

there in the ochre colours with a young indigenous boy in the middle. That has

been developed in Western Australia with the strong team of Harvey Coates

and Kelvin Kong, Francis Mannigan(?), Alistair, and Cheyanne and Paul.

There is our links, my email address there, and the Hear Our Heart Earbus

projects website, which is worth a look as well. As mentioned in the earlier

slides, the project is under the direction of Dubbo District Deaf Club, which was

stabled way back in 1997, so we are nearly about to have our 20th birthday

-- by myself and some other parents. So, there has been a long involvement. I

would … take questions.

TRUDY: Thank you, Donna. You just dropped out at the very end. Really

interesting session. We have some questions coming in already. How would

you suggest we get funding to build a screening team in our ISTH unit? We

are trained and certified in stages of gaining equipment but of course not

funded. Any tips or anyone in the department that you recommend we

contact?

DONNA: Is this the New South Wales department?

TRUDY: Yes.

DONNA: We have found that we had to build a strong partnership on the side

with -- that's why the NGO was established, non-government organisation --

through the charity. As teachers of the deaf through the department, they don't

provide funding for the screening. It is basically under Health. There could be

some obstacles there. It is fairly complex and has taken a lot of years of

wading through what would work for us, and what works out here may not

necessarily work in another area, particularly in the metropolitan. I certainly

urge you to try and keep trying, because we know that the children sitting in

our classrooms undiagnosed and even with the audiograms -- even with some


children being screened, we could have 10 screens and then no-one actually

acting on what those screens mean. That is what I am really trying to -- that is

what we are really trying to make sure doesn't happen in these kids, fall

through the gaps. Once they have a diagnosis, what happens to them then?

TRUDY: Do you have a single strategy that you use when working with

mainstream teachers to ensure they really get it?

DONNA: Keep chipping away. I like to make it real for them. Unpacking the

audiogram, showing them the visuals, giving them the block, ear plugs in the

ears, spelling test, making them have a bit of empathy for what the children

experience, that sometimes lets the light go on, so to speak.

My favourite strategies would be the more interactive, in a workshop, rather

than providing them with lots of reading.

TRUDY: Do you know if there are any resources or organisations available to

support Pacific Islander and Maori communities? There is a colleague in

Victoria who finds these communities experience very similar otitis media

issues to those experienced by Aboriginal and Torres Strait Islander students.

DONNA: I don't know of any resources specifically. That is why we have really

stressed that the project that we are working with in partnership with

HearOurHeart and our department of Education -- it is non-sector specific. We

are dealing with all children, I guess all races, ages. As I mentioned and you

would know yourself, otitis media isn't selective. My own children have had it

and I am not indigenous. My grandchild, who is Torres Strait Islander, he has

it but it is not necessarily because he is a Torres Strait Islander. It is peeling it

back and realising that otitis media can affect all kids and we need to be

perhaps looking to support them all.

TRUDY: Thank you. What role is classroom amplification playing in this work?

DONNA: In the Dubbo area itself, we have been very successful in

demonstrating through the program of the education for teachers screening,

then the results from the screening and unpacking those results as to, okay,

here you have seven or eight or nine children in your classroom who on a

given day had an issue. What strategies could be put in place for them to have

better access to hearing if they are not going to be eligible or will be waiting for


grommet surgery, if that is the case, for a long time.

Giving an example and always wearing it myself or ourselves when we are

presenting professional development makes it obvious and helps the teachers

themselves through the scenarios of the workshop when they have got blocked

ears, and we turn ourselves off and on and so forth. They again get a hands-on

experience of what it is like to hear with blocked ears and then with sound field

on and sound field off, and so forth.

We have been fortunate in a couple of our schools seeing the results and

turning around within days and ordering thousands of dollars of equipment,

which is not funded. They have had to find the funding within their school

budget but they have seen the necessity of it. And some of those schools

seven years down the track -- the teachers are still passionate about wearing

it. Those I mentioned who aren't, it is sometimes just a little reminder that this

is about the children, not necessarily about your choice of what you like and

don't like to wear around your neck or head. Yes, we have had a lot of

success and, as I said, not funded but the schools have really taken it on

board.

TRUDY: Sounds like a result of really quality professional support and

development. I have a question: how many of the children you work with are

fitted with hearing aids or bone conductor devices?

DONNA: Within the Department of Education itinerant support team’s caseload

there are around 60 children, but across the region with the children who have

ear health issues, that is certainly growing with the help of the diagnosis of the

history being shown -- that the ear health issues aren't resolving or surgery

hasn't been successful. There is a lot of multifaceted reasons why they may or

may not be fitted with devices. Sound field has helped some of these children

who are waiting to be fitted who can't have surgery or are waiting to have

surgery. We have had cases where children have been scheduled for surgery

but who have been no-shows. Back to the classroom teacher being active

and -- with her strategies and wearing sound field, and us helping with trying to

get more appointments with Australian Hearing in outreach areas has been


beneficial. Although, again, Australian Hearing isn't in every town out west and

so forth. It is really trying to deal with what works locally for each situation. Yes,

we do certainly have children with the bone conductor aids on soft bands,

children wearing hearing aids who don't have problems of perforations and so

forth. And some who then after a period of time whose ear health has improved

don't need to wear them. The prevention programs of nose-blowing have also

been shown to be beneficial in improvement in results in some schools, for

example, Wellington just last week, their results – Wellington, for example, last

week’s results showed that they had improved immensely due to the school

being really proactive with the prevention strategy of the breath, blow, cough,

chew. And the teacher has been right on board with that part of the program.

TRUDY: Medically, is there an optimal length of time that grommets should

stay in? Have you heard of them staying in so long that the skin grows over

them?

DONNA: Not in person but through experience and working closely with the

ear, nose and throat specialists, they do say that the grommet can fall out

within weeks, months but unlikely to stay in for years. It shouldn't have skin

growing over them. Hence the reason to be having regular ear health checks.

And certainly children with grommets seen at the HearOurHeart program the

grommets are checked regularly. Parents are also encouraged to be regularly

visiting their GP to have them checked as well. It should not get to a case

where a grommet is grown over.

TRUDY: I have certainly never heard of that happening, either.

DONNA: There are the old T-tube grommets, which are titanium that stay in for

longer. But I think these days with modern research and use of different

strategies certainly the ear, nose and throat surgeons have the opportunity to

be upskilled and looking at best practices and so forth. From our perspective,

we definitely refer them back to the ear, nose and throat or the GP for any

medical advice. We don't suggest that we know all the details about that

particular area.

TRUDY: Philosophical question: we have read that otitis media is a disease of

poverty. How true do you think that is or do you have a reflection on that?


DONNA: A lot of funding is put into prevention and awareness. Prevention

stating that we look at things like diet and hygiene, breastfeeding, keeping the

children away from cigarette smoke, wood fire smoke and so forth. These are

all, I guess, reasons why a child may have otitis media.

Another big one being crowded spaces in the home, sleeping conditions,

sharing of utensils and picking up bugs from each other. As is the case in

childcare centre. Childcare centres, with the age of the children being more

prone to otitis media, and having large groups of children all together, I guess

are environments where it is going to be more prevalent.

As far as making a call on it being poverty, my stand is that it can and does

affect everyone. Yes, it could come back to living conditions and so forth and

poor diet and so forth but, again, we would hope that you would -- many

communities these days that the parents through other programs, and there

are fantastic programs around for healthy eating and so forth that are

supported that don't cost much money. It is positive parenting and so forth to

help the parents again. That is a big part of what we are doing when we talk

with the parents. It is not just about that audiogram showing a perforation; how

did the perforation get to that stage and what can we do to help stop the

seriousness of that condition increasing?

So, keeping them out of dirty water when swimming, the rivers -- even pool

water that has leaves and so forth in it can all be a cause of having outer ear

infections, otitis media and so forth. There are a lot of reasons, but I won't

make a call on it all just being about poverty.

TRUDY: Sure, thank you. We have an inquiry about the nose blowing

program. Is there a way we could access resources about that?

DONNA: Yes, Sure. Sammi, who is in the referencing, produces a fantastic

program. It is linked back to quite an old program from the Northern Territory,

Breathe, Blow, Cough, or Breathe and Blow.

TRUDY: Breathe, Blow, Cough.

DONNA: The other components of wash and chew. Now exercise is put in


there. It is pretty much about being active, teaching the children how to blow

their noses properly, clearing one side and then the other. When we have our

healthy ears education sessions we teach the kids about the Eustachian tube

and they know what that word is … what could block the tube … the kids

understand how the ears work and how we should be keeping them healthy.

Breathe, blow -- so blowing our noses to clear the Eustachian tube, which can

keep our middle ears air filled, not fluid filled. Getting the mucus out and so

forth. Then exercise, washing hands and eating healthy food are all key

components, because they all go hand-in-hand. If you don't find Sammi's

references, I am happy to share them if you email me.

TRUDY: We could perhaps include the reference when we send the link to the

recording.

DONNA: Sure, yes.

TRUDY: There is a request for another website or name for the Wellington

study; a person is interested in the results.

DONNA: The Wellington -- is not really a study. Wellington have been part of

the screening component as well as education. Education has been really

strong from the get-go with Wellington. It is a local public school with a high

percentage of indigenous children, but we are finding a lot of children across

the sectors have been affected.

We have gathered the data across the years and have seen an improvement

and the learning and staff support are seeing an improvement in the children's

ear health and audio results and so forth as a result of doing the Breath, Blow,

Cough whilst Chew, as a result of the Keeping the Ears Healthy and the

prevention and awareness programs.

TRUDY: Do you know of any studies that have recorded data on Breathe, Blow

Cough or with the additional Wash and Chew?

DONNA: Not off the top of my head, no, sorry.

TRUDY: Me either. I was curious about whether you were more ahead of that

and perhaps if you have got colleagues in Northern Territory, Denise, you

might be aware of studies and if you send those to me I can share them with

participants as well. That looks like the end of the questions. It was nice to


have time to have an in-depth conversation after the workshop. Thank you

very much for that, Donna. Thank you to Roxane from Bradley Reporting for

captioning the session. There were some interesting terms in there. You have

done well, Roxane, so thank you. As I said, this event is accredited by the AG

Bell Academy and BOSTES, so please send through your details if you are

looking for those numbers. The next session is on 27 April and is about open

plan classrooms. We hope you can join us. Have a great day, everyone.

TRUDY: Hello, and welcome. On behalf of the RIDBC ......and share my personal involvement from being...

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