Natives Prone to Chronic Ear Infections, Which Endanger Hearing

Outpatient visits related to ear infections in children under 1 year was almost three times greater for Natives than for other U.S. infants in 2002.
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Sharon Navarrette (Cherokee/Creek/European) remembers having a lot of ear infections when she was a little girl. There were so many—and they were so severe—that her mother had to keep cotton balls in her child’s ears to absorb the drainage. She had trouble hearing and difficulty with speech, problems that persist.

The ear infections stopped when Navarrette was in fourth grade, but in her late 20s, she says, her face started to go numb, she would have dizzy spells and the ear infections returned. An ENT (ear, nose and throat specialist) discovered that she had a cholesteatoma, a cyst made up of dead skin cells, that was growing around her eardrum. The cyst had to be removed surgically lest she lose her hearing in that ear. The operation was successful and the doctor was able to reconstruct the small bones in her ear that had been damaged by the tumor using bone from her skull.

While cholesteatomas are rare, ear infections and deafness among American Indians and Alaska Natives are not. A study published by the journal Pediatrics in 2002 found that the incidence of outpatient visits related to ear infections (otitis media) for AI/AN children under 1 year of age was almost three times greater than for other U.S. infants. For AI/AN children from 1 to 4 years old, the rate was 1.5 times greater than for other kids. These results are consistent with those of earlier studies.

Chronic ear infections can cause hearing loss, speech delay and, later, reading problems and lower educational achievement. The Centers for Disease Control reported in 2005 that “American Indian or Alaska Native adults (6.4%) were nearly twice as likely as white adults (3.5%) and about four times as likely as Asian adults (1.8%) and black adults (1.6%) to have a lot of trouble hearing or to be deaf.” Researchers including Walter P. Kelley and Tony L. McGregor have documented Native American sign languages developed not for inter-tribal communication but rather for communication among deaf or hard-of-hearing members of the same tribe (“Keresan Pueblo Indian Sign Language”).

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ICTMN contacted Dr. Alec Thundercloud (Ho-Chunk Nation), a pediatrician and director of the Indian Health Service’s Office of Clinical and Preventive Services, to find out more about hearing loss in the AI/AN community. Thundercloud explained that risk factors for ear infections in children include “upper respiratory infections, day care or sibling day care attendance, short breastfeeding duration, prone sleeping while being formula fed, and exposure to tobacco smoke.”

The Eustachian tubes, small canals that connect the middle ear to the back of the nose and throat, can play a part in ear infections. When the tubes, whose purpose is to equalize air pressure within and outside the middle ear, become blocked because of an upper respiratory infection or other cause, the small hairs within the ear cannot remove fluid and infection from the middle ear. “Eustachian tube dysfunction usually follows the onset of an upper respiratory tract infection [a cold] or secondary to allergic rhinitis [runny nose]. Symptoms include aural fullness, popping ears, intermittent sharp ear pain, hearing loss, ringing of the ears, and a sense of loss of balance. There is evidence that the Eustachian tube of American Indians and Alaskan Natives is functionally different and may impair protective function, which leads to obstruction. This difference may account for the high prevalence of otitis media with perforation [of the eardrum],” says Thundercloud.

Parents have several measures at their disposal to prevent ear infections in children, according to Thundercloud. “Since formula-fed babies are more prone to ear infections, breastfeeding should be promoted in the first six to twelve months of life to possibly prevent ear infections. The Indian Health Service has embraced the Baby-Friendly Hospital Initiative, which promotes maternity care practices, education, and counseling on breastfeeding. According to the Centers for Disease Control and Prevention, mothers and babies experience short-term and long-term benefits from breastfeeding. Breastfed babies have a lowered risk of ear and respiratory infections, atopic dermatitis, type 2 diabetes, Sudden Infant Death Syndrome, and a reduction in childhood obesity,” he says.

“Other preventive measures … include reducing the infant’s exposure to environmental pollutants, such as tobacco smoke, and to other children with upper respiratory infections. Parents should make sure their children receive the recommended immunizations before they are exposed to diseases. Hand washing also should be part of a normal routine,” adds Thundercloud.

The cholesteatoma that Navarrette experienced—and that could have been the result of repeated ear infections—can erode or destroy the bones of the middle ear necessary for hearing, says Thundercloud. “Chronic suppurative otitis media [draining ear infection] is known to have a higher rate among American Indians and Alaskan Natives; however, acquired cholesteatoma [a cholesteatoma that is a complication of ear infections, as opposed to a cholesteatoma that is present at birth] is a relatively uncommon finding in this population.” The symptoms of a cholesteatoma include a persistent earache, ear drainage, ear pressure, hearing loss, dizziness, and facial muscle weakness. People with these symptoms should consult an otolaryngologist for evaluation.

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