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Yereth Rosen
Alaska Beacon

Bering Strait region children in households without running water are much more likely to get middle-ear infections, a newly published study confirmed.

Data from screenings of more than 1,600 schoolchildren in various communities in that part of western Alaska found that lack of running water – a chronic problem in rural Alaska – corresponded to a 53 percent higher rate of middle-ear infections, the study found. Young children, 3 to 6 years old, were most at risk, the study found.

The study, published in the journal Ear and Hearing, is part of a Norton Sound Health Corp.-supported program to address high rates of ear infections and the hearing loss that can result from them. Ultimately, the research should help health providers improve hearing screenings for children in the region, said co-author Samantha Kleindienst Robler, an audiologist at Norton Sound Health Corp. who is also an assistant professor at the University of Arkansas for Medical Sciences.

“Hearing screenings are an important element of the larger picture of ensuring children are ready to learn in the classroom and able to reach their full potential,” she said by email.

Though the study found a strong link between lack of running water and ear infections, that link did not extend to children’s hearing loss. Nor did the study find a link between other known risk factors, housing crowding and indoor smoke.

However, this study was just a first step in a process to better understand environmental factors in children’s ear diseases, Kleindienst Robler said. It used data from screenings of school-aged children performed over two academic years, 2017-18 and 2018-19, in which more than 17 percent showed middle-ear disease and over 11 percent showed signs of hearing loss.

Lacking flush toilets, people use plastic buckets, called "honeybuckets," for human waste. Shown here, Adolph Lupie empties the family "honey bucket" into an underground bunker in Tuntutuliak in western Alaska. Feb. 15, 2015 (Photo by Joaqlin Estus, ICT)

Ear infections do not always cause hearing loss, Kleindienst Robler said, but the results may also be skewed by some limitations in the methods used in the study. The measure used in the hearing screenings, an otoacoustic emission or OAE, is an important tool, she said, “but unfortunately is not the most sensitive at detecting the mild hearing loss that is most commonly found with middle ear infections.”

Follow-up studies are underway to better pinpoint the problems and their environmental causes. An ongoing study is examining environmental and nutritional factors, Kleindienst Robler said. “We hope that this new study, geared specifically to measure these factors, will be able to evaluate with greater accuracy the impact of environmental risk factors on ear and hearing health,” she said.

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A related study sponsored by the Norton Sound Health Corp. and conducted by largely the same group of researchers showed that telemedicine could provide speedier treatment of children with hearing problems. The study, published in July in The Lancet, examined outcomes for children who were screened by telemedicine compared to those screened through standard primary care. About two-thirds of the children who had ear problems detected by telemedicine got follow-up care, compared to only one-third of the children whose problems were detected through standard care, the study found. Of those who did get follow-up care, the telemedicine group received that service in an average of 41 days, compared to about three months for the other group, the study found.

Doctors and scientists have long tied poor water and sanitation service in rural Alaska and elsewhere in remote parts of the Arctic to health problems, with infants and young children especially affected. That is especially the case for respiratory diseases such as respiratory syncytial virus, or RSV, a chronic problem in rural Alaska. More recently, the link has been confirmed for COVID-19 in rural Alaska.

Edward Enoch, Yup'ik, unloads chunks of ice chipped out of a river and hauled home by snow-machine to melt for drinking, washing, and other uses. Location: Tuntutuliak, in western Alaska.

And high prevalence of ear infections and associated hearing loss among Alaska Native children has been documented for decades, at least as far back as the 1960s, when it was found to be correlated with higher rates of respiratory disease.

The Norton Sound research has provided some lessons about finding solutions to the longstanding problem.

One recommendation is to ensure that hearing screenings include measures for middle ear disease, something that is sometimes omitted, Kleindienst Robler said. “We have found from work in the Norton Sound region that it is critically important to include screening measures for both hearing loss and middle ear disease in rural areas where the rate of ear infections is high. This is to ensure no child who needs ear and hearing care is missed,” she said.

Other lessons are about the value of both telemedicine and community involvement in health research.

The research initiative is part of a “ground-up” project that is being guided by an advisory board and tribal council, said Kleindienst Robler, who has lived and worked in the region for over a decade. “In all our research projects, we have worked alongside community members and stakeholders,” she said.

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This article was originally published in the Alaska Beacon.