ObjectiveThis study aimed to determine and describe hearing loss among preschool children in a South African community representative of typical low- and middle income countries (LMIC). MethodChildren between the ages of 3–6 years received a hearing screening at their early childhood development (ECD) center. If a child failed the hearing screening, he/she was seen for a follow-up rescreen and diagnostic assessment if necessary at their ECD center or closest referral clinic. Diagnostic testing consisted of otoscopy, tympanommetry and pure-tone diagnostic audiometry. ResultsA total of 6424 children were screened at ECD centers with a referral rate of 24.9%. Follow-up assessments were conducted on 45.3% (725) of these children. Diagnostic testing revealed that 9.3% of children presented with impacted cerumen and 18.7% presented with a hearing loss (56.5% binaural). Binary logistic regression revealed no gender or age effects (p > 0.05). Conductive hearing loss (65.2%) was the most common type of hearing loss found in children. ConclusionsMost preschool children who failed the hearing screening and received a diagnostic assessment were in need of intervention services for conductive hearing losses, followed by sensorineural and mixed losses.