Sarcouncil Journal of Internal Medicine and Public Health

Abstract: Background: Chronic Otitis Media with Effusion (COME) is quite common among pre-school children in Iraq, however the effects of this condition on early language development in this particular context of sociocultural and environmental setting has not been well defined where To examine a dose-dependent effect of persistent COME, conductive hearing loss, and language acquisition among Iraqi preschool children and the effect of locally relevant risk factors and intervention outcomes. Methods: The study was a prospective longitudinal cohort study that was undertaken at 18 months in two tertiary pediatric otolaryngology departments in Iraq. A total of 96 children aged 24 -60 months with bilateral COME that lasted 3 months or more were recruited, and 48 age-, sex-, and socioeconomic status-matched controls. Findings: COME children had lower receptive (mean difference: -14.3 points; 95% CI: -19.1 -9.5; p= 0.001) and expressive language quotient ( -14.1 points; 95% CI: -19.3 -8.9; p= 0.001) than the controls. An observed dose-response effect was detected: longer effusion, more than 6 months (OR=6.17; 95% CI: 2.7613.8) and better-ear PTA 30 dB (OR=3.82; 95% CI: 1.81805) were independently predictive of clinically significant language delay. Risk was further aggravated by consanguinity and low socioeconomic status, as well as exposure to dust. Children with ventilation tubes or with hearing aids who were also given therapy at 12 months had faster language recovery (77.4 and 83.3 percent to norms, respectively) than those who had watchful waiting (56.3 percent; p=0.02). Conclusions: Persistent COME is a great and adjustable risk factor of early language delay in Iraqi preschool children. It is suggested to implement risk-stratified management including regular hearing check, culturally sensitive language surveillance, and intercessory action on children with bilateral effusion, hearing loss in the 30 dB and above, or compounding demographic characteristics to reduce developmental sequelae. The research should focus on supporting population-specific language evaluation instruments and explore genetic and environmental factors of persistent effusion in consanguineous communities.