Hearing Screening Program Research Articles

Real-time measurement of ambient noise levels during hearing screening in point-of-care settings

Access to hearing healthcare is a global issue that will necessitate several novel approaches to resolve. By evaluating the effectiveness of a hearing screening program in a non-traditional, acoustically hostile point-of-care setting, this study contributes to the global need for access to hearing healthcare. Specifically, this study measured the noise environment of a hearing screening conducted at the Minnesota State Fair, using a Sivantos Dosimeter and a custom Tabsint program, to measure ambient noise levels during hearing screenings using the Creare Wireless Automatic Hearing Testing System (WAHTS). The noise levels were measured and analyzed to determine the average and peak noise levels encountered during the hearing screenings. Normal hearing thresholds were obtained at ambient noise levels ranging from 40 to 65 dBSPL. These findings were compared to the recommended noise levels for hearing testing to determine whether current standards should be revised considering innovations aimed at improving access to hearing healthcare services in point-of-care settings.

Our results of the school-age hearing screening program

Objectives: This study evaluated the results of the hearing screening program in school-age children in our region and their etiologies. Patients and Methods: The school-age hearing screening audiometry results of 6,073 first-year primary school students (2,915 males, 3,158 females; mean age: 75.6±3.9 years; range, 66 to 84 years) performed between January 2019 and March 2020 were retrospectively scanned from the Ministry of Health National Hearing Screening Program database. The data of children who were referred due to hearing screening failure or risk factors were also scanned and included in the study. Results: One hundred eighty-three (3%) of the 6,073 first-year students who underwent screening audiometry were referred to an otolaryngologist due to failing the test or risk factors. Of the 183 referred children, 74 (40.5%) had impacted cerumen, and 48 (26.5%) had otitis media with effusion. Control audiometry tests of 61 (33%) children were normal. No statistically significant difference was observed in referral rates between the sexes. The hearing loss type was conductive hearing loss in all children with hearing loss. Conclusion: Although impacted cerumen is an easily preventable cause, it negatively affects academic performance, speech, and language development when left untreated. The high incidence of preventable and treatable hearing loss in preschool and school-age children and, although not observed in our study, the prevalence of acquired sensorineural hearing loss in these age groups shows the importance of hearing screening programs and the need for widespread use.

Modelling the cost-effectiveness of a newborn hearing screening programme; usability and pitfalls

Objective The EUSCREEN project concerns the study of European vision and hearing screening programmes. Part of the project was the development of a cost-effectiveness model to analyse such programmes. We describe the development and usability of an online tool to enable stakeholders to design, analyse or modify a newborn hearing screening (NHS) programme. Design Data from literature, from existing NHS programmes, and observations by users were used to develop and refine the tool. Required inputs include prevalence of the hearing impairment, test sequence and its timing, attendance, sensitivity, and specificity of each screening step. Outputs include the number of cases detected and the costs of screening and diagnostics. Study sample Eleven NHS programmes with reliable data. Results Three analyses are presented, exploring the effect of low attendance, number of screening steps, testing in the maternity ward, or screening at a later age, on the benefits and costs of the programme. Knowledge of the epidemiology of a staged screening programme is crucial when using the tool. Conclusions This study presents a tool intended to aid stakeholders to design a new or analyse an existing hearing screening programme in terms of benefits and costs.

Genotype and Phenotype Analyses of a Novel WFS1 Variant (c.2512C>T p.(Pro838Ser)) Associated with DFNA6/14/38.

The aim of this study is to contribute to a better description of the genotypic and phenotypic spectrum of DFNA6/14/38 and aid in counseling future patients identified with this variant. Therefore, we describe the genotype and phenotype in a large Dutch-German family (W21-1472) with autosomal dominant non-syndromic, low-frequency sensorineural hearing loss (LFSNHL). Exome sequencing and targeted analysis of a hearing impairment gene panel were used to genetically screen the proband. Co-segregation of the identified variant with hearing loss was assessed by Sanger sequencing. The phenotypic evaluation consisted of anamnesis, clinical questionnaires, physical examination and examination of audiovestibular function. A novel likely pathogenic WFS1 variant (NM_006005.3:c.2512C>T p.(Pro838Ser)) was identified in the proband and found to co-segregate with LFSNHL, characteristic of DFNA6/14/38, in this family. The self-reported age of onset of hearing loss (HL) ranged from congenital to 50 years of age. In the young subjects, HL was demonstrated in early childhood. At all ages, an LFSNHL (0.25-2 kHz) of about 50-60 decibel hearing level (dB HL) was observed. HL in the higher frequencies showed inter-individual variability. The dizziness handicap inventory (DHI) was completed by eight affected subjects and indicated a moderate handicap in two of them (aged 77 and 70). Vestibular examinations (n = 4) showed abnormalities, particularly in otolith function. In conclusion, we identified a novel WFS1 variant that co-segregates with DFNA6/14/38 in this family. We found indications of mild vestibular dysfunction, although it is uncertain whether this is related to the identified WFS1 variant or is an incidental finding. We would like to emphasize that conventional neonatal hearing screening programs are not sensitive to HL in DFNA6/14/38 patients, because high-frequency hearing thresholds are initially preserved. Therefore, we suggest screening newborns in DFNA6/14/38 families with more frequency-specific methods.

Factors influencing rehabilitation and education in children who have cochlear implants: An integrative review

Background: Several factors might impact the development of auditory, speech, and communication skills as well as academic performance in children with cochlear implants. These factors are important for these children’s transition to mainstream education. A lack of understanding among school staff about cochlear implant technology and these children’s special needs affects their school performance. Therefore, educational services need to include specialized sessions for nurses and teachers to meet the educational and special needs of these children.Aim: To explore the factors influencing the rehabilitation and education of children who have cochlear implants and highlight empirical evidence that will guide the development of educational sessions for school nurses and teachers who encounter these students.Methods: Whittemore and Knafl’s framework for integrative review guided this work. An electronic search was conducted using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and Academic Search Complete databases. Data was extracted and organized into the individual, interpersonal and organizational, and policy and environmental levels of the Socio-Ecological Model.Results: The individual-level factors are age at implantation, abnormal inner ear morphology, presence of additional disabilities, and hours of daily device use. The interpersonal and organizational factors include lower socioeconomic status, support within the family, and lack of experts at mainstream schools. The policy and environmental level factors are a failure in implementing hearing screening programs, lack of community awareness, and lack of clear education policies within the schools.Conclusions: Children face challenges at schools due to a lack of experts who are familiar with the needs of children with cochlear implants. To realize the children’s needs and provide proper educational support by school staff, teaching and training sessions need to be.

Development of a questionnaire to assess mothers’ knowledge, attitudes and practice with regard to childhood hearing loss and Universal Newborn Hearing Screening

The assessment of the validity and reliability of measurement tools in research provides quality data. However, evidence of the validity and reliability of parental knowledge and attitude regarding childhood hearing loss and newborn hearing screening is scarce. To design a Knowledge, Attitudes and Practice (KAP) survey tool regarding childhood hearing loss and a Universal Newborn Hearing Screening Programme of the rural Amajuba district, KwaZulu-Natal, South Africa, and then test for validity and test-retest repeatability. Face validity was conducted with 20 mothers and a content validity index was determined by two rounds of assessments, the first by 7 experts and the second by 3 experts. The kappa statistic was used to measure the stability of the tool using data from 160 mothers where repeated measurements were applied at two-week intervals. The feasibility of developing a tool was assessed by applying the criteria of science, population and resources. The KAP tool was developed with twenty-nine items. For face validity, 97% of the participants reported that the items were clear, wording was appropriate and easy to read and the language was natural. Content validity produced excellent results with a scale and content validity index of 1. Test-retest repeatability for the KAP tool was good with a Cohen's kappa coefficient of 0.87 (95% CI: 0.87, 0.87). Individually, the knowledge scale had a kappa of 0.86 (95% CI: 0.77, 0.95); the attitude scale had a kappa of 0.87 (95% CI: 0.76, 0.99): the practice scale had a kappa of 0.86 (95% CI: 0.75, 0.97) and the awareness scale had a kappa of 0.92 (0.83, 1.00). The development of a KAP tool was shown to be feasible, given sufficient time, funds, motivation and a study population. The study produced a valid and reliable tool that can be useful in generating quality evidence of a community's KAP with respect to childhood hearing loss and newborn hearing screening. Evidence gathered could be used to tailor health education and health promotion material for a Universal New-born Hearing Screening (UNHS) programme in a culturally sensitive manner to promote service uptake.

Newborn hearing screening in the UK

The newborn hearing screening programme (NHSP) exists to identify permanent childhood hearing impairment (PCHI) in babies born in the UK. Early identification of hearing loss facilitates the provision of hearing aids or a prompt referral for cochlear implantation to ensure children optimise speech, language and communication skills, with the hope that this translates to the best possible educational, mental health, social and quality of life outcomes. Diagnosis of hearing impairment allows aetiological investigations to be offered to look for a potential cause of the PCHI, and given the recent advances in genomic testing, this can facilitate testing for additional family members and future children if a genetic cause is identified. In this article, the authors describe the structure of the NHSP and illustrate referral pathways into the programme from primary care for the few babies that may have been missed or fallen outside the remit of the programme.

Management of neonatal central nervous system viral infections: Knowledge gaps and research priorities.

Congenital CMV, enteroviruses, human parechovirus and herpes simplex virus are all common causes of severe central nervous system (CNS) infection in neonates. The introduction of screening (i.e. newborn hearing screening programme), integration of molecular syndromic testing (i.e. multiplex polymerase chain reaction assays) and increase in sexually transmitted infections (i.e. anogenital herpes) have contributed to increases in each of these infections over the last decade. However, therapeutic options are highly limited in part due to the lack of epidemiological data informing trials. This review will describe our current understanding of the clinical burden and epidemiology of these severe neonatal CNS infections, outline the novel antiviral and vaccines in the pipeline and suggest future research studies which could help develop new therapeutics.

A Prospective Study of Genetic Variants in Infants with Congenital Unilateral Sensorineural Hearing Loss.

Children with unilateral sensorineural hearing loss (uSNHL) have a high risk of speech-language delays and academic difficulties. Still, challenges remain in the diagnosis of uSNHL. With a prospective cross-sectional design, 20 infants were consecutively recruited from a universal newborn hearing screening program and invited to genetic testing. Eighteen of the subjects agreed to genetic testing, 15 subjects with OtoSCOPE® v.9 screening 224 genes, and four subjects underwent targeted testing, screening for chromosomal abnormalities or 105-137 gene mutations. The genetic results were described together with the 20 infants' previously published auditory profiles and imaging results. Genetic causes for the uSNHL were found in 28% of subjects (5/18) including CHARGE syndrome (CHD7), autosomal recessive non-syndromic hearing loss (GJB2), Townes-Brocks syndrome (SALL1), Pendred Syndrome (SLC26A4) and Chromosome 8P inverted duplication and deletion syndrome. In subjects with comorbidities (malformation of fingers, anus, brain, and heart), 100% were diagnosed with a genetic cause for uSNHL (3/3 subjects), while 13% (2/15 subjects) were diagnosed without comorbidities observed at birth (p = 0.002). Genetic testing for congenital uSNHL is currently efficient for alleged syndromes, whereas genetic variants for non-syndromic congenital uSNHL need further research.

Neonatal hearing screening in Soba University Hospital, Khartoum, Sudan: a cross-sectional study

BackgroundHearing loss in children constitutes a serious obstacle to their optimal development; early detection of hearing disability is vital to improve the outcome of management; currently, in Sudan, there is no national neonatal hearing screening program. The aim of this study is to discuss the results of neonatal hearing screening among newborns admitted to neonatal intensive care unit (NICU) and well-baby nursery, at Soba University Hospital, Khartoum (Sudan), and to reflect the magnitude of risk factors for hearing impairment present in these two different groups of newborns.MethodsIn this hospital-based cross-sectional study, newborns who were admitted to the NICU or being observed in the well-baby nursery in the period from February 2014 to February 2019 were screened for hearing loss using automated otoacoustic emission (OAE) device after recording the risk factors for hearing loss according to the Joint Committee on Infant Hearing (JCIH) year 2007 position statement and after conducting a detailed ear and general physical examination. Newborns who failed this screening test were rescreened using the same device after 48 h, and if they failed again, they underwent confirmatory auditory brainstem response test when they are 6 months old.ResultsOne thousand one hundred twenty newborns were tested; 736 were NICU and 384 were well-baby nursery newborns. The prevalence of hearing impairment after confirmatory test was found to be 10.8 per 1000 in the NICU group and 5.2 per 1000 in the well-baby nursery group considering that the drop rate for the confirmatory test was 50% and 66% respectively which is very high and reflect the poor compliance to the program. The risk factors for hearing loss were more encountered in the NICU group compared to well-baby nursery group. Unmonitored ototoxic drug use was found to be very prevalent and need urgent reconsideration.ConclusionIn this study, the estimated prevalence of neonatal hearing impairment is alarming; risk factors are very evident especially in the NICU group; this reflect the urgent need for establishing an efficient national program for neonatal hearing screening and working to eliminate the preventable risk factors for neonatal hearing impairment in this developing country.

The Effect of Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio on the Severity of Diabetes Mellitus Type II and Air and Bone Conduction Hearing Threshold at Speech Frequency

Background: Diabetes Mellitus Type II (DMT II) is a metabolic disorder characterized by chronic hyperglycemia resulting from relative or absolute insulin deficiency. It can cause various complications, including hearing loss (HL). NLR and PLR can determine the severity of DMT II but are not yet known for HL. Methods: This research was quantitative, analytically observational, and cross-sectional, using medical record data from July-November 2022. The variables were age, NLR, PLR, FBG, the duration and severity of DMT II, the air and bone conduction thresholds at speech frequencies (500, 1000, 2000, and 4000 Hz). Results: 43 respondents (86 ears) met the inclusion and exclusion criteria. The mean age was 61.63 + 8.64 years, with more women (60.5%, 26/43) than men (39.5%, 17/43). The mean duration of DM was 10.45 + 8.77 years. The average severity level was 2.63 + 1.77, which means that respondents in this study had more than two complications on average. DM in the elderly > 60 years old has a risk of HL 9.839 times compared to those < 60. DM with a high NLR can increase the risk of HL by increasing the incidence of HL, bilateral sides, type and degree of HL, and air and bone conduction threshold. DM with NLR > 2.76 is more at risk of experiencing HL as much as 6.83 times compared to DM with NLR < 2.76. Factors that predict HL in DM are age, NLR, and FBG, which are 33.1%, while other factors determine 66.7%. The age, FBG, and NLR variables can predict hearing loss in DM with moderate accuracy (AUC 76.7%). Conclusion: Hearing loss needs to be added to the screening program for complications of diabetes mellitus. A hearing screening program is needed for DM aged > 60 years, FGB > 126 mg/dl and NLR > 2,76. NLR could be used to predict hearing loss incidents in DMT II.

Parent satisfaction of newborn hearing screening program during COVID-19 pandemic

Parent satisfaction of newborn hearing screening program during COVID-19 pandemic

Maternal and child predictors associated with loss to follow-up in the newborn hearing screening program: a cohort study in maternity hospitals in northeastern Brazil.

Analyze maternal and child predictors associated with loss to follow-up in the newborn hearing screening program at maternity hospitals in northeastern Brazil. Retrospective cohort study, including secondary data from infants (n=604) referred to the newborn hearing screening program in two maternity hospitals for monitoring and/or diagnosis. The predictors evaluated included socioeconomic factors, such as maternal age, marital status, income, schooling, place of residence, number of children and number of prenatal visits. In addition, maternal and child health factors, such as smoking and drug intake during pregnancy, consanguinity, congenital infections, craniofacial malformations, use of ototoxic drugs, syndromes and a history of hearing loss in the family. Statistical analysis was performed based on binary logistic regression models, using the stepwise method. The logistic regression model containing the number of prenatal visits and the history of hearing loss in the family was significant [χ2(2) =34.271; p<0.001]. The number of prenatal visits (OR = 2.343; 95% CI = 1.626 - 3.376) and family history of hearing loss (OR = 2.167; 95% CI = 1.507 - 3.115) were significant predictors. The other predictors were not significant. The results reveal that newborns whose mothers had ≤ 5 prenatal visits and those with a family history of hearing loss increased their likelihood of loss to follow-up by 2.3 and 2.1 times, respectively. It is important to provide subsidies for public health improvements in order to help advise, guide and educate mothers, especially during prenatal care.

Implementing hearing screening among children aged 0-59 months at established immunization clinics in Uganda: A multi-center study.

The prevalence of childhood hearing loss (HL) is high in low and middle income countries (LMICs), with many of the affected children facing communication delays and poor opportunities for education. Despite the increased advocacy for childhood hearing screening globally, Uganda has no established childhood hearing screening programs. This study set out to introduce hearing screening services by non-specialist health workers at routine immunization clinics among children aged 0-59 months and describe the prevalence and factors associated with failed hearing screening (HS) in these children. A cross-sectional multi-center study was conducted at immunization clinics at three regional referral hospitals (RRHs). A semi structured questionnaire was used to capture data on socio-demographic, clinical factors and the two stage Transient Evoked Oto-acoustic emissions (TEOAEs) screening performed on children aged 0-59 months. A child that failed two stage screening was considered to have failed HS. Logistic regression was used to calculate odds ratios (OR) for factors associated with failed HS. 1217 children were recruited at three RRHs, with a median age of 2 months (range: 0 to 59), half were male 52% (n=633). Overall 45 children failed two staged TEOAE screening giving a prevalence of failed HS of 3.7%, of these 27 (2.2%) and 18 (1.5%) failed unilaterally and bilaterally respectively. Children of rural residence (aOR=2.18, p=0.027), of low birth weight (aOR=0.42, p=0.045), with relatives having hearing loss (aOR=4.64, p= <0.001), who were admitted in hospital after birth (aOR=3.72, p=0.012) and a history of a childhood suppurative otitis media (aOR=9.53, p=0.015) all had increased odds of failed HS. The prevalence of failed screening is high. Implementation of childhood hearing screening by non-specialist health workers at immunization clinics using TEOAEs is possible and may be a necessary initial step in starting countrywide hearing screening in Uganda.

A Contribution to the History of Hearing Screening Programs: Dr. Muhiddin Hekimbaşızâde’s Recommendations for Hearing Screening at School Entry a Century Ago

A Contribution to the History of Hearing Screening Programs: Dr. Muhiddin Hekimbaşızâde’s Recommendations for Hearing Screening at School Entry a Century Ago

Universal Newborn Hearing Screening and Incidence of Hearing Loss in Ramathibodi Hospital: A 5 Years Experience (2014 to 2018)

Background: Congenital hearing loss is an important factor affecting a child’s speech and language development. The quality of universal newborn hearing screening and hearing intervention program plays an important role in assisting children with permanent hearing to achieve appropriate speech and language development. Objectives: To assess outcomes of the revised Ramathibodi Hospital universal newborn hearing screening (RUNHS) during 2014 to 2018, and to analyze the incidence of hearing loss in infants. Methods: This study was a retrospective analysis, all newborns delivered at Ramathibodi Hospital from January 1, 2014, to December 31, 2018 were included. Data were collected from medical records and evaluated the RUNHS outcomes compared with benchmarks. Descriptive statistics were used to analyze data. Results: Of 18 597 newborns, the screening coverage rate was 99. 8%, and the referral rate was 2.5%. The follow-up rate was 92.5%, and the diagnosis rate within 3 months of age was 20.1%. Among infants diagnosed with hearing loss, 42.9% received hearing aids by 6 months of age. The incidence of congenital permanent hearing loss was between 0.5 and 1.9 per 1000 live births. Conclusions: The outcomes met the benchmarks for coverage and referral rate, but the diagnosis and hearing aid fitting rate did not meet the criteria. As of the incidence, the amount of children with congenital hearing loss in this study was similar to those reported by others.

Cross-Sectional Study of Hearing Status in Primary Students in Mainstream and Special Schools

Background. The only way to prevent the negative outcomes of hearing loss in children (speech, mental, learning, socialization disorders) is early diagnosis of the pathology and rehabilitation onset. It can be provided by hearing screening programs for children of different ages, including school-age children. Hearing screening is not performed among school-age children in Russian Federation. Objective. The aim is to study the prevalence and structure of hearing disorders in students in mainstream and special (for children with visual impairments) schools to determine the strategy for implementing hearing screening of school-age children in Russian Federation. Methods. The study included children of two groups who had not previously been diagnosed with hearing disorders: group 1 — students of 1–4 grades of mainstream school, group 2 — students of 1–4 grades of special school (children with visual impairments) (St. Petersburg). The screening stage included otoscopy, tympanometry, otoacoustic emissions, pure tone audiometry. Children with any problems later underwent a complex hearing examination at Center of Pediatric Audiology (St Petersburg) to confirm the presence of hearing disorder and for disease differential diagnosis. The major indicator in this study is the percent (%) of children with confirmed hearing disorder in each group. The additional indicator is the proportion of various pathological conditions in hearing disorders’ structure (persistent disorders and hearing loss degree included). Study methods: otoscopy, tympanometry, pure tone audiometry, speech audiometry, otoacoustic emissions and auditory brainstem responses. Results. We have revealed abnormalities in 23% of 183 children from mainstream school. Hearing disorders were confirmed in 19.7% of children. Most children were diagnosed with temporary mild and moderate conductive hearing loss, whereas 3.9% were diagnosed with permanent (sensorineural) hearing loss. The total percent of children with confirmed hearing disorder was not significantly different in 148 children from special school. Therefore, they have 2.5 times more cases of permanent hearing loss and children with more severe hearing disorder. Conclusion. The obtained data confirm the hearing screening relevance in school-age children. Further studies are required to develop hearing screening protocol for school-age children considering the features of audiologic service and educational system in Russian Federation.

Newborn Hearing Screening at a Single Tertiary Care Hospital in the United Arab Emirates

Background and Aim: The United Arab Emirates has been successfully identifying and rehabilitating children having congenital hearing loss. A dearth of published data regarding the newborn hearing screening programs in the country demands the current study. The study aimed to find incidence of hearing loss and impact of known risk factors for hearing loss in a cohort of newborn babies in a single tertiary hospital in the United Arab Emirates. Methods: A retrospective analysis of hearing screening from January 2010 to December 2019 on a total of 37661 newborn babies were conducted using a screening protocol in auditory brainstem responses. Results: We report an overall incidence of 0.16% for congenital hearing loss in the current study population. Babies with prolonged stay in Newborn Intensive Care Unit (NICU) had an incidence of 0.87% and in babies with positive family history of hearing loss, it was as high as 2.2%. Chi square analysis revealed the significance of these risk factors (p&lt;0.001). 72% (44.61) received hearing rehabilitation by being fitted with cochlear implants and hearing aids except in few having other comorbidities. Conclusion: The newborn screening program has run a successful journey since the beginning in the country and the current study is an example. A majority of children identified has received early audiological rehabilitation helping the country in promoting inclusive education and better quality of life for them. Further studies may be implicated to see the outcome of early rehabilitation initiated in the identified population. Keywords: Hearing loss; newborn screening; newborn intensive care unit; family history; risk factors

Follow-up of children diagnosed with deafness in a neonatal hearing screening program in Manaus.

To evaluate the follow-up of children diagnosed with deafness in neonatal hearing screening and risk factors for hearing loss. Quantitative, cross-sectional, and retrospective study to evaluate factors associated with hearing loss and the follow-up of cases of children diagnosed with audiological dysfunction, by analyzing electronic medical records of 5,305 children referred to a Specialized Center in Type I Rehabilitation, from January/2016 to February/2020, in the city of Manaus, Amazonas. The statistical study used Pearson's chi-square test and binary logistic regression in which odds ratio scans were obtained with reliability intervals of 95%. Of the 5,305 children referred for the otoacoustic emission retest, 366 (6.9%) failed the retest. Children diagnosed with sensorineural hearing loss continued in the study, totaling 265 (72.4%). Only 58 (21.9%) children continued in the study to its end, of these 39 had received hearing aids at that point; and 16 (41%) had surgical indication for cochlear implants, of which only 3 (18.7%) had undergone surgery. Among the risk factors for hearing loss, we found 2.6 times more chance of failure in the otoacoustic emissions retest in those children who had a family history of hearing loss and ICU stay. Although the screening flow reaches a large part of live births, the dropout rates during the process are high, therefore, the socioeconomic and geographic characteristics of regions such as the Amazon should be considered as relevant factors to the evasion of rehabilitation programs of these children. Hospitalization in the neonatal ICU and family history of hearing loss in the investigations could be identified as the main and most important factors for alteration of the otoacoustic emissions retests.

Provider Perspectives: Identification and Follow-up of Infants who Are Deaf or Hard of Hearing.

Without timely screening, diagnosis, and intervention, hearing loss can cause significant delays in a child's speech, language, social, and emotional development. In 2019, Texas had nearly twice the average rate of loss to follow-up (LFU) or loss to documentation (LTD; i.e., missing documentation of services received) among infants who did not pass their newborn hearing screening compared to the United States overall (51.1 vs. 27.5%). We aimed to identify factors contributing to LFU/LTD among infants who do not pass their newborn hearing screening in Texas. Data were collected through semistructured qualitative interviews with 56 providers along the hearing care continuum, including hospital newborn hearing screening program staff, audiologists, primary care physicians, and early intervention (EI) program staff located in three rural and urban public health regions in Texas. Following recording and transcription of the interviews, we used qualitative data analysis software to analyze themes using a conventional content analysis approach. Frequently cited barriers included problems with family access to care, difficulty contacting patients, problems with communication between providers and referrals, lack of knowledge among providers and parents, and problems using the online reporting system. Providers in rural areas more often mentioned problems with family access to care and contacting families compared to providers in urban areas. These findings provide insight into strategies that public health professionals and health care providers can use to work together to help further increase the number of children identified early who may benefit from EI services. · Infants with suspected hearing loss may not receive timely diagnosis or early intervention.. · We interviewed healthcare providers in Texas along the hearing care continuum.. · Findings suggest strategies to increase the number of children with hearing loss identified early..