Neurobiological insights into central auditory processing dysfunction following early-life otitis media.
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Otitis media with effusion (OME) is one of the most common pediatric disorders and a leading cause of transient conductive hearing loss during critical periods of brain development. Beyond peripheral effects, growing evidence indicates that OME may influence central auditory processing through a combination of molecular, cellular, and systems-level mechanisms. Pro-inflammatory cytokines, including interleukin-1β and tumor necrosis factor-α, together with reduced auditory input, can activate microglia and astrocytes, limit brain-derived neurotrophic factor (BDNF) signaling, and disrupt MAPK pathways that support synaptic plasticity and myelin maintenance. Epigenetic processes-such as DNA methylation of plasticity-related genes, histone deacetylation, and altered microRNA expression-provide further routes through which early sensory deprivation may shift cortical circuit maturation. Animal studies strongly support these mechanisms, yet pediatric human evidence remains heterogeneous, largely indirect, and frequently shows reversibility. Electrophysiological and imaging studies identify central auditory delays or white-matter changes in subsets of children, but many of these normalize over time. Randomized controlled trials confirm that tympanostomy tubes restore hearing for several months but consistently fail to demonstrate durable benefits for language, cognition, or central processing, highlighting the need for central biomarkers and longitudinal outcomes. Taken together, current findings support biologically plausible but not definitive links between early-life OME and the later development of central auditory processing disorder (CAPD). To clarify causality and clinical significance, future research must employ biomarker-anchored, longitudinal designs capable of identifying which children are most vulnerable and at what developmental stages interventions such as auditory training or combined therapies may be most effective.