Long-term hearing outcomes in children with a history of recurrent acute otitis media

Purpose: While the immediate complications of acute otitis media (AOM) are well known, its long-term audiological effects remain poorly understood. This study aimed to assess the prevalence of audiometric alterations at least five years after the onset of recurrent AOM (rAOM) and examine their relationship with clinical history. Methods: This study was conducted at the Audiology Clinic of the Policlinico of Milan (Italy). Children born in 2015–2016 with documented rAOM were eligible. Exclusion criteria included genetic syndromes, craniofacial abnormalities, immunological deficits, recent head trauma or ear surgery, noise exposure, ototoxic drugs, or systemic disorders. Between May 1, 2023, and May 31, 2024—at least five years after rAOM onset—each child underwent rigorous audiological and otological assessments, including otomicroscopy, tympanometry, and pure-tone audiometry. Results: A total of 141 children (83 males, 58 females; mean age: 95.5 ± 5.9 months) were assessed. Pure-tone audiometry revealed mild conductive hearing loss (CHL) in six children (4.3%). High-frequency (6000–8000 Hz) sensorineural hearing loss (SNHL) was observed in 28 children (19.9%), while 10 (7.1%) had low-frequency (250–500 Hz) SNHL. Low-frequency CHL was identified in 12 (8.5%) patients. Additionally, a 6000 Hz dip (≥10 dB compared to adjacent frequencies) was detected in 35 children (24.8%). The most common otomicroscopic alterations were localized tympanosclerosis (22.3%), extensive tympanic membrane retraction (11.7%), and retraction pockets (10.6%). More than eight AOM episodes correlated with high-frequency SNHL (p = 0.03). Chronic OME history was linked to worse audiometric and otomicroscopic outcomes (p < 0.01). Conclusions: These findings highlight the need for long-term audiological follow-up in children with rAOM. The 6000 Hz dip may represent a subclinical marker of cochlear vulnerability in this population. Our results could help reshape pediatric hearing surveillance protocols and hold global relevance for early hearing loss diagnosis, given the high worldwide prevalence of rAOM.