Long-Term Otomicroscopic and Audiometric Outcomes in Children with a History of Recurrent Acute Otitis Media

Introduction: The study aimed to evaluate the prevalence of otomicroscopic and audiometric alterations at least 5 years after recurrent acute otitis media (rAOM) onset, and to investigate the relationship between these findings and clinical history. Methods: This study was conducted at the Audiology Clinic of the Policlinico of Milan (Italy). Children born in 2015-2016 with a history of rAOM (which began at least 5 years prior) were included. From May 2023 to May 2024, patients were assessed by a pediatric otologist using otomicroscopy, tympanometry, and pure-tone audiometry. Two groups were identified: those with rAOM and spontaneous tympanic membrane perforation (STMP-rAOM group), and those with rAOM without STMP (rAOM group). Results: A total of 141 children (mean age: 95.5 ± 5.9 months) were assessed. Most otomicroscopic evaluations were normal (44.3%), with common alterations being “localized tympanosclerosis” (22.3%), “localized retraction areas” (11.7%), and “retraction pockets” (10.6%). Only 6 children (4.3%) had mild conductive hearing loss (HL). Twenty-eight children (19.9%) had high-frequency (6000-8000 Hz) sensorineural HL, 10 (7.1%) had low-frequency (250-500 Hz) sensorineural HL, and 12 (8.5%) showed low-frequency conductive HL. A 6000 Hz dip was found in 35 children (24.8%). Otomicroscopic alterations were significantly associated with the number of AOM episodes, STMP episodes in the first year, history of chronic OME and adenoidal hypertrophy. The STMP-rAOM group had more retraction pockets (20.5% vs. 7.9%, p = 0.03). Conclusions: Our study highlights the need for long-term audiologic follow-up in children with rAOM, due to the risk of permanent otomicroscopic and hearing alterations.