Quantitative Association Between Otorrhea Frequency and Sensorineural Hearing Risk in Pediatric Chronic Otitis Media.

Background/Objectives: Chronic otitis media (COM) in children carries a risk of irreversible sensorineural hearing loss (SNHL), which impairs language development and academic performance, although an objective clinical threshold does not exist to identify patients requiring urgent surgical intervention. Methods: We retrospectively analyzed 60 pediatric patients (aged 5-18 years) who underwent surgery for COM or cholesteatoma and performed linear regression, Pearson's correlation, and receiver operating characteristic (ROC) curve analyses to quantify the relationship between otorrhea frequency and shifts in bone conduction (BC) threshold at least six months postoperatively. Results: Otorrhea frequency was significantly correlated with BC deterioration (r = 0.327, p = 0.011, R2 = 0.107). ROC analysis identified five or more episodes as the optimal cutoff for predicting a clinically significant BC shift of ≥10 dB (area under the curve = 0.712; sensitivity 75.0%, specificity 80.0%). Bacteriological findings, including the presence of non-skin commensal pathogens, did not significantly influence hearing outcomes (p = 0.721). Conclusions: Five or more otorrhea episodes constitute a quantitative, equipment-free red flag for imminent cochlear injury in pediatric COM, and this threshold provides primary care physicians and pediatricians a simple, age-independent criteria for timely surgical referral to prevent lifelong auditory morbidity.