Background: Chronic otitis media (COM), encompassing otitis media with effusion (OME) and chronic suppurative otitis media (CSOM), represents the most prevalent pediatric illness and the leading cause of acquired hearing loss in children worldwide. The auditory deficits associated with COM have profound implications for language acquisition, cognitive development, educational attainment, and social integration during critical developmental windows. Objective: This systematic review aims to synthesize available evidence on the association between chronic otitis media and hearing loss in children, examining prevalence estimates across different populations, the severity and characteristics of hearing impairment, risk factors that modify this association, and the relationship between disease characteristics and auditory outcomes. Methods: A systematic literature search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library for studies published between 2022 and 2026. Studies were included if they examined children aged 0-18 years with COM, utilized objective audiological assessments (pure-tone audiometry, tympanometry, or wideband absorbance), and reported original research data on the association between COM and hearing loss. Seven studies met the inclusion criteria, comprising cross-sectional, cohort, and retrospective designs. Quality and risk of bias were assessed using Joanna Briggs Institute checklists. A narrative synthesis was conducted due to clinical and methodological heterogeneity. Results: The included studies demonstrated a consistent and strong association between COM and hearing loss in children. Global estimates indicate that 34.71 million children under 15 years were affected by COM-induced hearing loss in 2021, representing an 11.32% increase over three decades. Prevalence varied substantially across populations, reaching 55% in Greenlandic children and 34.8% in Alaska Native children. Hearing loss was typically mild-to-moderate conductive impairment, with mean pure-tone averages ranging from 22-45 dB HL. The severity of hearing loss correlated with disease chronicity, effusion characteristics, and specific risk factors including cleft palate, genetic susceptibility (CPT1A Arctic variant), and socioeconomic disadvantage. Wideband absorbance demonstrated strong negative correlations with air-bone gap (R² = 0.94), enabling precise prediction of conductive hearing loss severity. Protective factors included breastfeeding (43% relative risk reduction). Surgical interventions, including tympanostomy tube insertion and rapid maxillary expansion, produced significant and sustained improvements in audiological outcomes and speech-language development. Conclusions: This systematic review provides robust evidence that COM is strongly and consistently associated with hearing loss in children, with the highest burden concentrated in indigenous populations, low- and middle-income countries, and children with anatomical or genetic vulnerabilities. The mild-to-moderate hearing loss typical of COM, while often clinically underrecognized, is sufficient to compromise developmental outcomes during critical periods. The evidence supports targeted screening programs in high-risk populations, timely surgical intervention for persistent disease, and public health strategies addressing modifiable risk factors including breastfeeding promotion and improved healthcare access.