Central auditory and tinnitus consequences of pediatric chronic otitis media with effusion

Surgical intervention for pediatric chronic otitis media with effusion (COME) reverses hearing loss imposed by fluid in the middle ear space. Current recommendations are treatment implementation for bilateral COME, but only treatment consideration for unilateral COME. The latter recommendation could result in unrecognized binaural processing impairment and tinnitus arising from interaural threshold differences. This prospective, cross-sectional study contrasted three cohorts (A, normal hearing and without COME, N = 12; B, bilateral COME, N = 11; and, C, unilateral COME, N = 7) using a portable spatial release from masking (SRM) test protocol and tinnitus loudness measurement. The participant ages ranged from 5.4 to 13.7 years (mean=9) and average pure tone thresholds in the poorer ear of COME cohorts were comparable at ∼30 dB. The unilateral COME cohort showed poorer SRM performance (p = 0.012). Children with greater interaural threshold asymmetry were more likely to have a greater reduction in benefit from spatial release from masking, regardless of COME status or degree of hearing loss (F = 5.1, p = 0.033). Tinnitus prevalence was 71 % in unilateral COME and 55 % in bilateral COME cohorts. Tinnitus loudness was associated with mood symptoms severity and hearing-related quality of life. Early evidence for significant central auditory and tinnitus consequences of pediatric unilateral COME prompts reappraisal of treatment recommendations that call for only consideration of surgical evacuation of middle ear fluid and placement of a tympanostomy tube. Longitudinal studies to examine central auditory function in children with COME that deploy intervention arms will be necessary to support any change to current clinical practice.