Chronic Otitis Media in Childhood: Impact on Hearing, Language Development and Cognitive Educational Outcomes

Abstract

Otitis media in childhood encompasses a spectrum of clinical enti- ties with high prevalence and potential for significant functional consequences, particularly when persistent or recurrent. Within this spectrum, two conditions are especially relevant in the context of chronic otitis: persistent otitis media with effusion (OME), characterised by the presence of middle ear fluid without signs of acute infection, and chronic suppurative otitis media (CSOM), defined by chronic inflammation and infection with tympanic membrane perforation and recurrent or persistent otorrhoea. These conditions are of particular importance because they occur at critical periods for language acquisition, consolidation of pre-academic skills and maturation of attentional and self-regulatory mecha- nisms, potentially introducing periods of conductive hearing loss (often fluctuat- ing in OME and more persistent in CSOM) [1,2]. From a developmental perspective, the central hypothesis guiding this review is that of a cascade effect: middle ear pathology → degradation or instability of auditory input → increased listening effort and reduced speech perception quality (particularly in noise) → vulnera- bility in emerging language and literacy → indirect impact on academic perfor- mance and cognitive functions supporting learning (attention, working memory and executive functions). This hypothesis is conceptually consistent with mod- els of listening effort and cognitive energy expenditure [1,3]. The aim of this study is to provide an integrative review of: (1) the epidemiology and pathophysiology of chronic otitis in childhood; (2) the audiological and functional profile of associ- ated hearing impairment; and (3) evidence regarding impacts on language, learn- ing and cognitive functions, including potential moderators. The discussion con- cludes with implications for screening, interdisciplinary assessment and clinical and educational intervention [4–6].