A survey of strategies for the early diagnosis of hearing loss in infants: a scoping review

Lopes, Allan Dayner Silva; Carvalho Filho, Antônio Pereira de; Silva, Sanmara de Andrade; Fonseca, Rodrigo Oliveira da; Almeida, Maiara Cristine Oliveira de; Lucena, Maria Helena Medeiros de Sá Lima; Taveira, Karinna Veríssimo Meira; Cavalcanti, Hannalice Gottschalck

doi:10.1590/2317-1782/e20250375pt

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Sumário

Critical Review or Scoping Review • CoDAS 38 (5) • 2026 • https://doi.org/10.1590/2317-1782/e20250375en linkcopy

A survey of strategies for the early diagnosis of hearing loss in infants: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To map the strategies used for the early diagnosis of hearing loss in infants.

Research strategies A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Embase, Web of Science, LILACS, Google Scholar, and ProQuest, with no restrictions on language or publication period. The search was initially performed in October 2024 and updated in January 2026. Controlled descriptors (DeCS/MeSH) and keywords related to hearing loss, newborn hearing screening, and early diagnosis were used. The protocol was registered in the Open Science Framework.

Selection criteria Primary studies addressing strategies for the early diagnosis of hearing loss in children up to two years of age were included. Secondary studies, case reports, guidelines, duplicate publications, and studies without full-text availability were excluded. Study selection was performed independently by reviewers, with disagreements resolved by consensus.

Data analysis Extracted data included study design, population, diagnostic instruments, strategies, and care setting. A descriptive and narrative synthesis was conducted, grouping evidence according to diagnostic approaches.

Results Of the 16,946 records identified, 58 studies published between 1991 and 2025 met the eligibility criteria. Universal Newborn Hearing Screening (UNHS) predominated, particularly protocols combining otoacoustic emissions and automated auditory brainstem response. Complementary strategies included two-stage screening, early retesting, community-based programs, genetic screening, and additional electrophysiological assessments. Variability in protocol implementation and persistent structural inequalities were observed.

Conclusion UNHS remains the cornerstone of early diagnosis of hearing loss in infants, with effectiveness dependent on well-organized care pathways and integration between screening, diagnosis, and follow-up.

Keywords:
Neonatal Screening; Hearing Loss; Infant; Early Diagnosis; Scoping Review

	Authors (Year)	Methodological Characteristics		Procedures	Outcomes
	Authors (Year)	Study Design	Sample	Procedures	Outcomes
1	Webb and Stevens (1991)(²⁶)	Comparative	250	TEOAE / ABR	Newborn hearing screening should begin with TEOAE due to its efficiency and cost-effectiveness. ABR should be used for diagnostic confirmation and differentiation of hearing loss type.
2	Tudehope et al. (1992)(²⁷)	Prospective	149	ABR / BOA / Immittance	Early auditory assessment in very low birth weight neonates is essential for identifying hearing loss, particularly conductive loss. The combination of ABR, behavioral audiometry, and immittance measures provides a comprehensive diagnostic approach.
3	Morlet et al. (1998)(²⁸)	Prospective	1.531	TEOAE / ABR	The screening process successfully identified hearing loss in a high-risk population, highlighting the need for repeated assessments during the first year of life for children with initially abnormal results.
4	Aidan et al. (1999)(²⁹)	Cohort	1.727	TEOAE	The study demonstrated the feasibility and limitations of TEOAE as a universal newborn hearing screening tool.
5	Watkin and Baldwin (1999)(³⁰)	Retrospective	100	TEOAE / ABR / BOA	Newborn hearing screening is effective for early identification of hearing impairment; however, adequate follow-up and effective parental communication are essential to confirm diagnosis and initiate early intervention.
6	Prieve et al. (2000)(³¹)	Prospective	43.311	TEOAE / AABR / ABR	Outpatient indicators improved over time, with significant differences between neonates admitted to the NICU and those from routine nurseries, in addition to regional disparities requiring further investigation.
7	Shehata-Dieler et al. (2000)(³²)	Prospective	1.349	ABR / OAE	The BeRapHon® method proved to be an effective and highly specific tool for universal newborn hearing screening.
8	Stewart et al. (2000)(³³)	Prospective	11.711	AABR / ABR / Tympanometry / TEOAE	Universal hearing screening using AABR proved highly effective and feasible across different hospitals, with low follow-up costs and minimal interference in parent–infant bonding.
9	Baumann and Schorn (2001)(³⁴)	Cohort	102	TEOAE / BOA / ABR	Behavioral band testing was inadequate for hearing screening, detecting only 61.5% of cases. In contrast, otoacoustic emissions testing effectively identified hearing loss, and automated devices such as Echoscreen demonstrated high specificity.
10	Owen et al. (2001)(³⁵)	Prospective	683	OAE	Community-based newborn hearing screening conducted by healthcare workers was feasible, well accepted, and associated with high population coverage and low false-positive rates.
11	Lin et al. (2002)(³⁶)	Prospective	6.765	TEOAE / ABR	The use of TEOAE as a universal newborn hearing screening tool was feasible, accurate, and cost-effective.
12	Iwasaki et al. (2003)(³⁷)	Prospective	4.085	AABR / ABR / OAE / BOA	A two-stage AABR screening protocol effectively reduced referral and false-positive rates among newborns.
13	Rouev et al. (2004)(³⁸)	Prospective	1.838	AABR / ABR	Universal newborn hearing screening in Bulgaria using a two-stage protocol with AABR and ABR proved effective and cost-effective for early hearing loss detection, despite challenges related to follow-up of referred cases.
14	White et al. (2005)(³⁹)	Prospective	86.634	OAE / AABR	The newborn hearing screening protocol using OAE and AABR identified most infants with permanent hearing loss; however, a substantial proportion would have passed the AABR screening.
15	Widen et al. (2005)(⁴⁰)	Prospective	973	OAE / AABR / VRA	Newborn hearing screening should include continuous monitoring beyond the neonatal period. VRA was appropriate for most infants, although examiner experience influenced diagnostic effectiveness.
16	Yee-Arellano et al. (2006)(⁴¹)	Prospective	3.066	AABR / ABR	Even with a reduced pilot sample, the rates of identified hearing loss were similar to those reported in other countries. The study highlighted the feasibility of the program and the need for expansion, emphasizing operational and follow-up aspects.
17	De Capua et al. (2007)(⁴²)	Prospective	19.700	OAE / ABR / BOA	Diagnostic ABR was preferable to automated ABR due to its greater diagnostic accuracy.
18	Tatli et al. (2007)(⁴³)	Prospective	711	TEOAE / ABR	A two-stage TEOAE newborn hearing screening program was feasible and well accepted by families. Effective screening was achieved in 96% of neonates admitted to the nursery.
19	Olusanya et al. (2008)(⁴⁴)	Cross-sectional	1.330	TEOAE / ABR	Hospital-based universal newborn hearing screening was feasible in urban Nigerian settings, even when conducted by non-specialized personnel after brief training, showing effective detection and low referral rates.
20	Dantas et al. (2009)(⁴⁵)	Retrospective	1.626	TEOAE	The findings reinforced the importance of implementing and maintaining newborn hearing screening programs and may support comparisons in regional and multinational studies.
21	Ohl et al. (2009)(⁴⁶)	Retrospective	1.461	Automated OAE / OAE / ABR	The screening program for high-risk infants enabled early management of 60 deaf children, although loss to follow-up after screening remained substantial.
22	Geal-Dor et al. (2010)(⁴⁷)	Comparative	1.545	TEOAE / BOA	Newborn hearing screening using TEOAE was objective and favored early detection and adherence. Subsequent behavioral screening was useful for identifying late-onset or progressive hearing deficits, including auditory neuropathy. Both methods were complementary rather than interchangeable.
23	Tasci et al. (2010)(⁴⁸)	Retrospective	16.975	TEOAE / ABR	The three-stage protocol was accurate and noninvasive; however, reorganization into a two-stage approach (initial TEOAE followed by ABR) was suggested to improve coverage.
24	Yu et al. (2010)(⁴⁹)	Retrospective	6.336	DPOAE / AABR	The combined DPOAE and AABR screening protocol proved feasible and more efficient for newborn hearing screening.
25	Daniel and Lim (2012)(⁵⁰)	Retrospective	100.237	OAE / AABR / ABR	The newborn hearing screening program in Singapore was effective for early identification of hearing impairment and provided opportunities for timely intervention.
26	Friderichs et al. (2012)(⁵¹)	Cross-sectional	6.227	DPOAE	Low screening coverage highlighted the need for dedicated personnel, rather than regular clinic staff, to achieve broader and more effective screening rates.
27	Lim et al. (2012)(⁵²)	Retrospective	10.879	AABR / ABR / Tympanometry	The AABR screening protocol demonstrated acceptable referral rates and predictive values.
28	Martines et al. (2012)(⁵³)	Comparative	412	TEOAE / Tympanometry / ABR	A high prevalence of auditory neuropathy spectrum disorder was identified among high-risk infants. Family history and NICU admission were independent predictors. Combined screening (TEOAE + ABR) demonstrated better performance than isolated TEOAE, especially for detecting auditory neuropathy in high-risk neonates.
29	Zhang et al. (2012)(⁵⁴)	Prospective	10.043	DPOAE / AABR / Genetic screening	Combined hearing and genetic screening improved identification of newborns at risk for hearing loss, including cases associated with recessive mutations or drug-induced hearing impairment.
30	Arslan et al. (2013)(⁵⁵)	Prospective	2.229	Automated TEOAE / AABR	Automated TEOAE proved feasible for newborn hearing screening, and the two-stage protocol effectively reduced false-positive referral rates.
31	Borkoski Barreiro et al. (2013)(⁵⁶)	Retrospective	26.717	Automated TEOAE / TEOAE / ABR / ASSR	The early hearing detection program achieved coverage above 95%, although referral rates for diagnostic confirmation remained below recommended levels. Nevertheless, the protocol proved suitable for hospital routine and ensured substantial screening coverage.
32	Hsu et al. (2013)(⁵⁷)	Prospective	3.361	TEOAE / AABR	The universal newborn hearing screening program using AABR demonstrated high coverage and low referral rates.
33	Kuki et al. (2013)(⁵⁸)	Comparative	50	BOA / TEOAE / AABR / ABR / ASSR	Combining BOA with TEOAE and/or AABR enabled accurate, cost-effective, and well-accepted hearing screening. Due to its simplicity, low cost, and acceptability, BOA may be especially useful in low-resource settings where universal screening is not yet implemented.
34	Mishra et al. (2013)(⁵⁹)	Prospective	1.101	DPOAE / ABR	The combination of DPOAE and ABR was effective for universal newborn hearing screening and early detection of hearing loss in children younger than 2 years.
35	Qi et al. (2013)(⁶⁰)	Prospective	10.983	TEOAE / ABR	High screening coverage and reduced referral rates were feasible and practical among newborns of migrant workers.
36	Amini et al. (2014)(⁶¹)	Case series	149	TEOAE / Tympanometry / ABR	A significant association was observed between low birth weight and abnormal otoacoustic emissions. Altered OAE responses were identified in 2% of asphyxiated newborns.
37	Çelik et al. (2014)(⁶²)	Retrospective	142.128	TEOAE / ABR	Hearing screening proved essential for all newborns to support developmental outcomes. Infants with risk factors required repeated testing for early diagnosis, and improvements in prenatal care could contribute to reducing hearing impairment rates.
38	Huang et al. (2014)(⁶³)	Prospective	13.315	TEOAE / AABR / ABR	The combination of TEOAE and AABR followed by complete audiological assessment constituted an effective universal newborn hearing screening model for high-risk infants admitted to the NICU.
39	Canet et al. (2016)(⁶⁴)	Retrospective	14.247	OAE / ABR	The screening program proved useful; however, improvements in tracking and follow-up processes were necessary. Effectiveness was limited by loss to follow-up, reinforcing the importance of electronic records and coordinated care.
40	Chrobok et al. (2019)(⁶⁵)	Descriptive	—	OAE / ABR	Newborn hearing screening techniques (TEOAE and ABR) were effective, objective, and rapid. Universal implementation was considered essential for early identification of hearing loss and intervention before six months of age.
41	Wasser et al. (2019)(⁶⁶)	Prospective	179.000	TEOAE / ABR	The national newborn hearing screening program in Israel achieved high coverage and significantly reduced the age at diagnosis and habilitation among infants with hearing loss.
42	Dey et al. (2020)(⁶⁷)	Prospective	264	DPOAE / ABR	Hearing impairment was associated with hyperbilirubinemia requiring phototherapy or exchange transfusion, suggesting its role as a predictive indicator for hearing loss development.
43	McInerney et al. (2020)(⁶⁸)	Retrospective	604	DPOAE / ABR	The findings highlighted the need to address barriers associated with loss to follow-up and recommended the use of strategies to improve parental engagement.
44	Nishad et al. (2020)(⁶⁹)	Prospective	1.000	TEOAE / ABR	A well-structured protocol including initial OAE screening and ABR retesting was necessary for early hearing loss detection. Higher incidence rates were observed among high-risk neonates. OAE was useful for rapid screening, whereas ABR remained essential for definitive diagnosis.
45	Kelly et al. (2021)(⁷⁰)	Retrospective	31.984	ABR	Delaying ABR testing to approximately 10–11 hours after vaginal delivery and 30–32 hours after cesarean delivery significantly improved pass rates. Inclusion of a third post-discharge test further reduced referral rates.
46	Shim et al. (2021)(⁷¹)	Retrospective	3.059	AABR / ABR / Tympanometry / ASSR / TEOAE	The two-stage AABR screening protocol demonstrated effective performance within JCIH-recommended referral rates (3–4%). The study validated this method as appropriate for hospital-based newborn hearing screening.
47	Arora et al. (2022)(⁷²)	Prospective	1.200	TEOAE / ABR / ASSR	Newborn hearing screening was feasible in low-resource settings, particularly when associated with community programs and parental education strategies.
48	Gharibi and Khavidaki (2022)(⁷³)	Cross-sectional	7.700	TEOAE / AABR / ABR	A comprehensive newborn hearing screening program was essential to ensure timely diagnosis and treatment, with early identification and intervention being decisive for effective auditory rehabilitation.
49	Hajare and Mudhol (2022)(⁷⁴)	Comparative	800	DPOAE / AABR / ABR	A centralized screening facility could benefit hospitals lacking resources for universal or high-risk hearing screening programs.
50	Khaimook et al. (2022)(⁷⁵)	Retrospective	1.579	OAE / ABR / Tympanometry	The universal newborn hearing screening program was effective in early identification and referral of children with hearing loss, highlighting family support and interdisciplinary care as key factors for improved outcomes.
51	Mazlan et al. (2022)(⁷⁶)	Retrospective	50.569	TEOAE / AABR / ABR	The program achieved excellent screening coverage; however, performance remained below expectations regarding referral, follow-up, and diagnostic confirmation. Program revision and optimization were recommended to maintain effectiveness and relevance.
52	Dutra et al. (2023)(⁷⁷)	Cross-sectional	104	TEOAE / VRA / BOA / ABR / ASSR	Limited access to hearing healthcare services delayed diagnostic confirmation and intervention. Maternal age, education, and distance from healthcare services did not significantly influence service utilization.
53	Badusha et al. (2024)(⁷⁸)	Prospective	117	DPOAE / ABR	The high incidence of hearing impairment among high-risk infants reinforced the importance of newborn hearing screening. Collaboration between healthcare professionals and parents was essential for effective screening and intervention.
54	Kgare and Joubert (2024)(⁷⁹)	Retrospective	2.302	Tympanometry / ABR / ASSR	Community-based universal newborn hearing screening proved feasible in a rural setting; however, high loss-to-follow-up rates and delayed screening age compromised the effectiveness of early diagnosis.
55	Jennings and Isaacson (2025)(⁸⁰)	Retrospective	2.069	TEOAE / AABR	Although newborn hearing screening before hospital discharge achieved high coverage, early diagnostic effectiveness was compromised by outpatient loss to follow-up (43%) and socioeconomic barriers such as transportation, insurance, and childcare responsibilities.
56	Chandrakapure et al. (2025)(⁸¹)	Retrospective	28.025	BOA / TEOAE / AABR / ABR	Universal newborn hearing screening conducted at a tertiary healthcare center achieved high coverage and excellent diagnostic performance; however, poor adherence to post-screening follow-up limited the effectiveness of early diagnosis.
57	Ndoleriire et al. (2025)(⁸²)	Cross-sectional	12.996	TEOAE / AABR / ABR / Tympanometry	Quality-controlled newborn hearing screening proved feasible in a public hospital setting; however, large variations in coverage and high loss-to-follow-up rates compromised the effectiveness of early hearing loss diagnosis.
58	Parangrit et al. (2025)(⁸³)	Retrospective	6.472	OAE / AABR	The implementation of an earlier and more structured newborn hearing screening protocol increased screening coverage and timely diagnosis, although loss to follow-up remained a major limitation in the care pathway.

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[1] Caption: BOA = Behavioral Observation Audiometry; AABR = Automated Auditory Brainstem Response; ABR = Auditory Brainstem Response; ASSR = Auditory Steady-State Response; DPOAE = Distortion Product Otoacoustic Emissions; Immittance = Immittance Measures; TEOAE = Transient Evoked Otoacoustic Emissions; Tympanometry = Tympanometry; VRA = Visual Reinforcement Audiometry

[2] Source: Page et al.(²⁴)