A survey of strategies for the early diagnosis of hearing loss in infants: a scoping review.
Allan Dayner Silva Lopes, Antônio Pereira de Carvalho Filho, Sanmara de Andrade Silva and 5 others
Across 58 studies, whether a baby's hearing loss is caught early depends more on follow-up systems than on which screening test is used.
Losing track of a baby after a failed screen is the main reason diagnosis is delayed.
Key findings
1Otoacoustic emissions (OAE) was the most commonly used screening tool, appearing in 89.6% of the 58 included studies, followed by auditory brainstem response (ABR) at 77.5% and automated ABR (AABR) at 41.3%. Two-stage protocols combining OAE and AABR were described in about a third of the studies.
2The review concludes that the effectiveness of early diagnosis depends more on how the healthcare pathway is organised — follow-up, coordination between services, and continuity of care — than on which specific diagnostic test is used.
3The most consistently reported barrier across the included studies was loss to follow-up after a failed screen, along with communication failures between maternity hospitals and specialised services, lack of equipment, and logistical difficulties accessing care.
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What it does not show
The included studies are methodologically heterogeneous — 35 of 58 are descriptive observational (mostly cross-sectional or retrospective), so the review can map what is done but cannot rank which strategies work best. The evidence base is heavily concentrated in high-income countries (United States, India, China, Türkiye); only 3 studies came from Latin America and 4 from Africa, so the findings may not transfer to low-resource settings where the barriers are different. Sample sizes across the included studies ranged from 50 to 179,000, making direct comparison between studies difficult and limiting the review to descriptive synthesis rather than quantitative pooling. Grey literature (theses, institutional reports, technical documents) was excluded, which may omit relevant programme evaluations from public health settings. As a scoping review, the synthesis is narrative and descriptive; it does not assess the quality of individual studies or estimate effect sizes.
Declared interests
No funding source is declared and no conflicts of interest are reported. The authors state 'nothing to declare' in both English and Portuguese.
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