Deadly Ears in Deadly Hands: Aboriginal Health Professional-led ear and hearing assessment and discharge planning for Aboriginal children at risk of severe ear infection

At screening, all children will receive an ear examination from the clinical trial team. This ear examination will take place at the participant's bedside and involve video otoscopy and tympanometry. It is anticipated that this ear examination would take approximately 10 minutes. A sticker indicating the diagnosis of the child's ear health condition (e.g. acute otitis media, bilateral otitis media with effusion) will be placed in the child's hospital notes. This will not include any management recommendations. Children randomised to the intervention group will receive standard care (as the control group) plus additional support from an Aboriginal Ear Health Professional (AEHP), who could be either an Aboriginal Health Practitioner (AHP), Aboriginal Health Worker (AHW) or Aboriginal Registered Nurse (ARN). The AEHP will conduct a hearing, talking and understanding assessment of the child (using PLUM and HATS https://plumandhats.nal.gov.au/) if age-appropriate. This assessment takes approximately 10 minutes. They will also a basic hearing screen when possible (approx. 4 years and over) performed using an automated hearing test via a tablet/mobile phone and noise cancelling headphones, which will take approximately 5 minutes to perform. All assessments will take place at the bedside in the ward, unless the family indicate that they would prefer this be conducted elsewhere (for example, outside or in the cafeteria). Based on these findings, the screening ear examination and a review of the child's medical ear health history, the AEHP will create a personalised recommended ear health management plan for the child. This management plan will be guided by the "2020 Otitis Media Guidelines for Aboriginal and Torres Strait Islander Children" and details given to the treating medical team. Required follow-up medical visits and referrals to specialists will be arranged and the primary health centre will be notified. Adherence to this intervention will be via audit of the electronic medical records up to 8 months after hospital discharge. The AEHP will spend time with the family of the child regularly (approximately daily) until the child is discharged from hospital. This time will be used to educate the family about ear health management, as well as offering more general health advice and support in the hospital environment. Time spent with each family will vary depending on the family's needs. Families in both the intervention and control groups will receive printed educational material regarding the most relevant to them of the five most important chronic conditions affecting children in Royal Darwin Hospital: severe otitis media; early childhood malnutrition; iron deficiency anaemia; chronic suppurative lung disease; and acute rheumatic fever. These materials are from readily available resources, such as RHD Australia, Bronchiectasis Toolbox, Department of Health etc.