Statement of Principles concerning otitis externa (Balance of Probabilities) (No. 26 of 2021)
1Statement of Principles concerning otitis externa (Balance of Probabilities) (No. 26 of 2021)
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The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.
Dated 24 December 2020
The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:<br>
<br> <br>Professor Nicholas Saunders AO<br>Chairperson<br>
Contents
1 Name
2 Commencement
3 Authority
4 Repeal
5 Application
6 Definitions
7 Kind of injury, disease or death to which this Statement of Principles relates
8 Basis for determining the factors
9 Factors that must exist
10 Relationship to service
11 Factors referring to an injury or disease covered by another Statement of Principles
Schedule 1 - Dictionary
1 Definitions
1 Name
This is the Statement of Principles concerning otitis externa (Balance of Probabilities) (No. 26 of 2021).
2 Commencement
This instrument commences on 25 January 2021.
3 Authority
This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.
4 Repeal
The Statement of Principles concerning otitis externa No. 59 of 2012 (Federal Register of Legislation No. F2012L01803) made under subsections 196B(3) and (8) of the VEA is repealed.
5 Application
This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.
6 Definitions
The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.
7 Kind of injury, disease or death to which this Statement of Principles relates
(1) This Statement of Principles is about otitis externa and death from otitis externa.
Meaning of otitis externa
(2) For the purposes of this Statement of Principles, otitis externa:
(a) means an infectious or non-infectious inflammation of the external auditory canal; and
(b) includes:
(i) acute diffuse otitis externa;
(ii) acute localised otitis externa (furunculosis);
(iii) eczematous otitis externa;
(iv) malignant otitis externa;
(v) acquired cholesteatoma of the external auditory canal; and
(vi) otomycosis.
Note 1: Otitis externa may be acute or chronic.
Note 2: Typical symptoms of otitis externa include ear pain, pruritus, discharge and hearing loss.
Note 3: Otitis externa may be accompanied by inflammation of the auricle.
Note 4: otomycosis is defined in the Schedule 1 - Dictionary.
(3) While otitis externa attracts ICD‑10‑AM code H60, H62.0, H62.1, H62.2, H62.3 or H62.4, in applying this Statement of Principles the meaning of otitis externa is that given in subsection (2).
(4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.
Death from otitis externa
(5) For the purposes of this Statement of Principles, otitis externa, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's otitis externa.
Note: terminal event is defined in the Schedule 1 - Dictionary.
8 Basis for determining the factors
On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that otitis externa and death from otitis externa can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.
Note: MRCA, relevant service and VEA are defined in the Schedule 1 - Dictionary.
9 Factors that must exist
At least one of the following factors must exist before it can be said that, on the balance of probabilities, otitis externa or death from otitis externa is connected with the circumstances of a person's relevant service:
(1) participating in aquatic activities within the ten days before the clinical onset of otitis externa;
Note: aquatic activities is defined in the Schedule 1 - Dictionary.
(2) being exposed to hot and humid weather conditions or heavy rains, on at least ten days within the 30 days before the clinical onset of otitis externa;
Note: hot and humid weather conditions is defined in the Schedule 1 - Dictionary.
(3) undergoing a course of therapeutic radiation for cancer, where the affected ear was in the field of radiation, before the clinical onset of otitis externa;
(4) having trauma to the external auditory canal of the affected ear within the ten days before the clinical onset of otitis externa;
Note: Examples of trauma include a blunt or penetrating injury, a surgical procedure and blast force.
(5) having a foreign object or implement inserted into, or removed from, the external ear canal of the affected ear within the ten days before the clinical onset of otitis externa;
Note: An example of a foreign body or implement is an ear lavage instrument used for aural irrigation.
(6) blocking the external auditory canal of the affected ear with an extrinsic aural device for a cumulative period of at least 16 hours within the seven days before the clinical onset of otitis externa;
Note: extrinsic aural device is defined in the Schedule 1 - Dictionary.
(7) having an acquired, persistent narrowing or obstruction of the external auditory canal of the affected ear at the time of the clinical onset of otitis externa;
Note 1: Examples of causes of narrowing or obstruction of the external auditory canal include:
(a) benign or malignant neoplasm;
(b) cerumen accumulation;
(c) exostosis of the external auditory canal; and
(d) granuloma.
Note 2: exostosis of the external auditory canal is defined in the Schedule 1 - Dictionary.
(8) having an inflammatory skin disease at the time of the clinical onset of otitis externa, where the skin disease involves the external auditory canal of the affected ear;
Note 1: Examples of an inflammatory skin disease include allergic or irritant contact dermatitis, seborrhoeic dermatitis, lichen planus, psoriasis and eczema.
Note 2: Irritant or allergic contact dermatitis of the external auditory canal may be caused by shampoos, ototopical medications or accidental chemical splashes to the ear.
(9) having an infectious, autoimmune or granulomatous disease at the time of the clinical onset of otitis externa, where the disease involves the external auditory canal of the affected ear;
Note: Examples of an infectious, autoimmune or granulomatous disease include herpes zoster, relapsing polychondritis and sarcoidosis.
(10) having chronic suppurative otitis media, involving the middle ear of the affected side, within the 30 days before the clinical onset of otitis externa;
Note: chronic suppurative otitis media is defined in the Schedule 1 - Dictionary.
(11) having diabetes mellitus at the time of the clinical onset of otitis externa;
(12) being in an immunocompromised state as specified at the time of the clinical onset of otitis externa;
Note: immunocompromised state as specified is defined in the Schedule 1 - Dictionary.
(13) for otomycosis only, taking a course of oral antibiotic therapy or having ototopical therapy for the treatment of otitis externa of the affected ear within the two weeks before the clinical onset of otitis externa;
Note: otomycosis is defined in the Schedule 1 - Dictionary.
(14) participating in aquatic activities within the ten days before the clinical worsening of otitis externa;
Note: aquatic activities is defined in the Schedule 1 - Dictionary.
(15) being exposed to hot and humid weather conditions or heavy rains, on at least ten days within the 30 days before the clinical worsening of otitis externa;
Note: hot and humid weather conditions is defined in the Schedule 1 - Dictionary.
(16) undergoing a course of therapeutic radiation for cancer, where the affected ear was in the field of radiation, before the clinical worsening of otitis externa;
(17) having trauma to the external auditory canal of the affected ear within the ten days before the clinical worsening of otitis externa;
Note: Examples of trauma include a blunt or penetrating injury, a surgical procedure and blast force.
(18) having a foreign object or implement inserted into, or removed from, the external ear canal of the affected ear within the ten days before the clinical worsening of otitis externa;
Note: An example of a foreign body or implement is an ear lavage instrument used for aural irrigation.
(19) blocking the external auditory canal of the affected ear with an extrinsic aural device for a cumulative period of at least 16 hours within the seven days before the clinical worsening of otitis externa;
Note: extrinsic aural device is defined in the Schedule 1 - Dictionary.
(20) having an acquired, persistent narrowing or obstruction of the external auditory canal of the affected ear at the time of the clinical worsening of otitis externa;
Note 1: Examples of causes of narrowing or obstruction of the external auditory canal include:
(a) benign or malignant neoplasm;
(b) cerumen accumulation;
(c) exostosis of the external auditory canal; and
(d) granuloma.
Note 2: exostosis of the external auditory canal is defined in the Schedule 1 - Dictionary.
(21) having an inflammatory skin disease at the time of the clinical worsening of otitis externa, where the skin disease involves the external auditory canal of the affected ear;
Note 1: Examples of an inflammatory skin disease include allergic or irritant contact dermatitis, seborrhoeic dermatitis, lichen planus, psoriasis and eczema.
Note 2: Irritant or allergic contact dermatitis of the external auditory canal may be caused by shampoos, ototopical medications or accidental chemical splashes to the ear.
(22) having an infectious, autoimmune or granulomatous disease at the time of the clinical worsening of otitis externa, where the disease involves the external auditory canal of the affected ear;
Note: Examples of an infectious, autoimmune or granulomatous disease include herpes zoster, relapsing polychondritis and sarcoidosis.
(23) having chronic suppurative otitis media, involving the middle ear of the affected side, within the 30 days before the clinical worsening of otitis externa;
Note: chronic suppurative otitis media is defined in the Schedule 1 - Dictionary.
(24) having diabetes mellitus at the time of the clinical worsening of otitis externa;
(25) being in an immunocompromised state as specified at the time of the clinical worsening of otitis externa;
Note: immunocompromised state as specified is defined in the Schedule 1 - Dictionary.
(26) for otomycosis only, taking a course of oral antibiotic therapy or having ototopical therapy for the treatment of otitis externa of the affected ear within the two weeks before the clinical worsening of otitis externa;
Note: otomycosis is defined in the Schedule 1 - Dictionary.
(27) inability to obtain appropriate clinical management for otitis externa.
10 Relationship to service
(1) The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.
(2) The factors set out in subsections 9(14) to 9(27) apply only to material contribution to, or aggravation of, otitis externa where the person's otitis externa was suffered or contracted before or during (but did not arise out of) the person's relevant service.
11 Factors referring to an injury or disease covered by another Statement of Principles
In this Statement of Principles:
(1) if a factor referred to in section 9 applies in relation to a person; and
(2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;
then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
Schedule 1 - Dictionary
Note: See Section 6
1 Definitions
In this instrument:
aquatic activities means an activity in which the external ear opening is submerged in water, or which causes retention of water in the ear canal.
Note: Examples of aquatic activities include swimming, underwater diving, water sports and trekking through watercourses.
chronic renal failure means:
(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months; or
(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or
(c) undergoing chronic dialysis.
chronic suppurative otitis media means a recurrent or continuous infective disorder of the middle ear characterised by perforation of the tympanic membrane and aural discharge.
exostosis of the external auditory canal means abnormal bone growth within the external auditory ear canal caused by irritation from prolonged or repeated exposure to cold wind and water. It is also known as surfer's ear.
extrinsic aural device means an instrument which occludes the external auditory canal or creates a seal over the ear.
Note: Examples of extrinsic aural devices include:
(a) ear buds or plugs;
(b) hearing aids;
(c) headphones; and
(d) stethoscopes.
hot and humid weather conditions means:
(a) ambient humidity exceeding 40 percent; and
(b) maximum temperature exceeding 30 degrees Celsius.
immunocompromised state as specified means a condition of substantially lowered immune function, such as would occur in the following conditions or circumstances:
(a) being treated with an immunosuppressive drug;
(b) having a haematological or solid organ malignancy;
(c) having chronic renal failure;
(d) having infection with human immunodeficiency virus;
(e) having severe malnutrition; or
(f) undergoing solid organ, stem cell or bone marrow transplantation.
Note: chronic renal failure and immunosuppressive drug are also defined in the Schedule 1 - Dictionary.
immunosuppressive drug means a drug or an agent which results in substantial suppression of immune responses.
Note: Examples of an immunosuppressive drug include:
(a) chemotherapeutic agents used for the treatment of cancer;
(b) corticosteroids, other than inhaled or topical corticosteroids;
(c) drugs used to prevent transplant rejection; and
(d) tumour necrosis factor-α inhibitors.
MRCA means the Military Rehabilitation and Compensation Act 2004.
otitis externa—see subsection 7(2).
otomycosis means a fungal infection of the external auditory canal.
relevant service means:
(a) eligible war service (other than operational service) under the VEA;
(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or
(c) peacetime service under the MRCA.
Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.
terminal event means the proximate or ultimate cause of death and includes the following: