Otitis media — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 62 of 2022

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting otitis media or death from otitis media with the circumstances of a person's relevant service:

1. (1)
   having an upper respiratory tract infection within the 28 days before the clinical onset of otitis media;
2. (2)
   having partial or complete obstruction of the Eustachian tube of the affected side within the 7 days before the clinical onset of otitis media;

   Note: Obstruction of the Eustachian tube usually involves symptoms of Eustachian tube dysfunction and negative pressure in the middle ear. Symptoms of Eustachian tube dysfunction include aural fullness, a feeling of pressure or being clogged, pain, popping and crackling in the ears. Signs include a serous middle ear effusion and retraction of the tympanic membrane.

3. (3)
   having allergic rhinitis or sinusitis within the 7 days before the clinical onset of otitis media;
4. (4)
   having a space-occupying mass within the nasopharynx at the time of the clinical onset of otitis media;

   Note: Examples of a space-occupying mass within the nasopharynx include malignant neoplasm of the nasopharynx, lymphoma, benign neoplasm of the nasopharynx such as pleomorphic adenoma and oncocytoma, and nasopharyngeal cyst such as an oncocytic cyst.

5. (5)
   undergoing a course of therapeutic radiation for cancer, where the head or upper neck was in the field of radiation, before the clinical onset of otitis media;

   Note: Radiotherapy given to the nasopharynx or adjacent areas for cancer may include either or both Eustachian tubes in the field of radiation. This may result in otitis media in the ear contralateral to the side of the cancer.

6. (6)
   having an acute rupture of the tympanic membrane of the affected side within the 3 months before the clinical onset of otitis media;

   Note: Circumstances in which an acute rupture of the tympanic membrane can occur include intrusion of a foreign body such as an implement, stick or projectile into the tympanic cavity and surgical procedures involving the tympanic membrane.

7. (7)
   having chronic perforation of the tympanic membrane of the affected side before the clinical onset of otitis media;

   Note: Chronic perforation may be the result of previous otitis media. Chronic perforation includes tympanostomy tubes (“grommets”), usually inserted for acute recurrent otitis media or chronic otitis media.

8. (8)
   having an episode of otitic barotrauma involving the affected ear within the 7 days before the clinical onset of otitis media;

   Note: Otitic barotrauma is also known as otic barotrauma.

9. (9)
   having tuberculosis or nontuberculous mycobacterial disease at the time of the clinical onset of otitis media;
10. (10)
    having gastro-oesophageal reflux disease at the time of the clinical onset of otitis media;
11. (11)
    swimming, diving or water-skiing, where such activities allow water to enter the oropharynx, within the 7 days before the clinical onset of otitis media;
12. (12)
    having ascariasis or myiasis of the ear, nose or throat at the time of the clinical onset of otitis media;

    Note: Myiasis is an infestation of maggots.

13. (13)
    having ANCA-associated vasculitis at the time of the clinical onset of otitis media;

    Note: ANCA (anti-neutrophil cytoplasmic antibody)-associated vasculitis refers to necrotizing vasculitis that primarily affects small and medium blood vessels and includes granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis.

14. (14)
    having infection with human immunodeficiency virus before the clinical onset of otitis media;
15. (15)
    taking an immunosuppressive drug for organ or tissue transplantation before the clinical onset of otitis media;

    Note: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.

16. (16)
    having an upper respiratory tract infection within the 28 days before the clinical worsening of otitis media;
17. (17)
    having partial or complete obstruction of the Eustachian tube of the affected side within the 7 days before the clinical worsening of otitis media;

    Note: Obstruction of the Eustachian tube usually involves symptoms of Eustachian tube dysfunction and negative pressure in the middle ear. Symptoms of Eustachian tube dysfunction include aural fullness, a feeling of pressure or being clogged, pain, popping and crackling in the ears. Signs include a serous middle ear effusion and retraction of the tympanic membrane.

18. (18)
    having allergic rhinitis or sinusitis within the 7 days before the clinical worsening of otitis media;
19. (19)
    having a space-occupying mass within the nasopharynx at the time of the clinical worsening of otitis media;

    Note: Examples of a space-occupying mass within the nasopharynx include malignant neoplasm of the nasopharynx, lymphoma, benign neoplasm of the nasopharynx such as pleomorphic adenoma and oncocytoma, and nasopharyngeal cyst such as an oncocytic cyst.

20. (20)
    undergoing a course of therapeutic radiation for cancer, where the head or upper neck was in the field of radiation, before the clinical worsening of otitis media;

    Note: Radiotherapy given to the nasopharynx or adjacent areas for cancer may include either or both Eustachian tubes in the field of radiation. This may result in otitis media in the ear contralateral to the side of the cancer.

21. (21)
    having an acute rupture of the tympanic membrane of the affected side within the 3 months before the clinical worsening of otitis media;

    Note: Circumstances in which an acute rupture of the tympanic membrane can occur include intrusion of a foreign body such as an implement, stick or projectile into the tympanic cavity and surgical procedures involving the tympanic membrane.

22. (22)
    having chronic perforation of the tympanic membrane of the affected side before the clinical worsening of otitis media;

    Note: Chronic perforation may be the result of previous otitis media. Chronic perforation includes tympanostomy tubes (“grommets”), usually inserted for acute recurrent otitis media or chronic otitis media.

23. (23)
    having an episode of otitic barotrauma involving the affected ear within the 7 days before the clinical worsening of otitis media;

    Note: Otitic barotrauma is also known as otic barotrauma.

24. (24)
    having tuberculosis or nontuberculous mycobacterial disease at the time of the clinical worsening of otitis media;
25. (25)
    having gastro-oesophageal reflux disease at the time of the clinical worsening of otitis media;
26. (26)
    swimming, diving or water-skiing, where such activities allow water to enter the oropharynx, within the 7 days before the clinical worsening of otitis media;
27. (27)
    having ascariasis or myiasis of the ear, nose or throat at the time of the clinical worsening of otitis media;

    Note: Myiasis is an infestation of maggots.

28. (28)
    having ANCA-associated vasculitis at the time of the clinical worsening of otitis media;

    Note: ANCA (anti-neutrophil cytoplasmic antibody)-associated vasculitis refers to necrotizing vasculitis that primarily affects small and medium blood vessels and includes granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis.

29. (29)
    having infection with human immunodeficiency virus before the clinical worsening of otitis media;
30. (30)
    taking an immunosuppressive drug for organ or tissue transplantation before the clinical worsening of otitis media;

    Note: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.

31. (31)
    inability to obtain appropriate clinical management for otitis media;

Aggravation-only factors: the factors in subsections 9(16) to 9(31) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.