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Objective: Cochlear implantation (CI) is the definitive treatment for profound hearing loss in children and adults. Operating on an infected ear is considered a challenge; the institution of cochlear implant the presence of otitis media with effusion (OME) prior to CI surgery has created a debate among neuro-otologists: treat the OME first or go ahead with surgical intervention. This study was conducted to determine whether cochlear implantation in patients with OME at the time of surgery has any influence on the procedure, post-operative complications and surgical outcome. Methods: Retrospective descriptive analysis of data collected from records of patients who underwent CI in a tertiary care hospital from 2000-2018 was done. The age targeted was 6 months to 14 years old, excluding all adults, and those who had their operations outside the chosen institution. Results: Out of 369 children, 175 had OME preceding surgery compared to 194 who did not have OME. Intra-operative oedematous hypertrophied middle ear mucosa was observed only in OME patients (n=18, P <0.050). Moreover, among the OME patients, six cases developed mild intra-operative bleeding compared to only one case from non-OME group (P <0.050). Overall, there was no significant difference in post-operative surgical complications between the two groups (P >0.050). Conclusion: The presence of OME is associated with intra-operative technical difficulties, such as impaired visualization and bleeding. However, OME is not determinative on performing cochlear implantation in terms of post operative complications and outcome. Therefore, there is no need to delay the implantation until the OME resolves. Keywords: Cochlear implantation, otitis media with effusion, children, and sensorineural hearing loss