Do rastreamento ao diagnóstico da perda auditiva em crianças: uma revisão de escopo e a análise da idade de detecção em Alagoas

Abstract

Childhood hearing loss represents a significant public health challenge due to its direct impacts on language, communication, and social inclusion, making it essential to understand both the epidemiological profile of this population and the most effective diagnostic strategies. This dissertation, composed of two complementary studies, sought to broaden the understanding of childhood hearing loss in Brazil while mapping international evidence on early diagnosis. The first study was an observational, crosssectional, and quantitative investigation analyzing 3,495 clinical records of children aged 0 to 12 years, treated between 2012 and 2024 at Specialized Rehabilitation Centers in Maceió, a regional reference for hearing diagnosis and rehabilitation. Results showed a predominance of males (55.5%) and a high prevalence of bilateral sensorineural hearing loss (82%). The main risk indicators were neonatal intensive care unit stay longer than five days, use of ototoxic drugs, and low birth weight (<1500 g), identified in 42% of the children. Although neonatal hearing screening was recorded in 80.9% of cases, only 12.4% were performed within the recommended 30-day timeframe. The mean age at diagnosis was 2.1 years and at intervention onset 2.4 years, with only 28.1% receiving intervention by six months of age, as recommended by the 1-3-6 benchmark. The second study, a scoping review, mapped 10,713 records from major international databases and gray literature, of which 53 met eligibility criteria and described strategies for early diagnosis of hearing loss in infants up to two years old. The evidence highlighted universal neonatal hearing screening as the most recurrent and effective approach, particularly two-stage protocols combining otoacoustic emissions and automated auditory brainstem response. Additional strategies included targeted approaches for at-risk populations, parental awareness initiatives, combined use of electrophysiological and behavioral assessments, and complementary etiological testing. The methodological heterogeneity across studies underscores the urgent need for international standardization and stronger integration among healthcare services to ensure timely diagnosis. Together, the two investigative approaches presented in this dissertation provide a comprehensive overview: despite the broad implementation of neonatal hearing screening, significant gaps remain in timely diagnosis and intervention, alongside inequities in service coverage and quality. The findings emphasize the importance of strengthening maternal and child healthcare networks, enhancing the effectiveness of universal neonatal hearing screening, and adopting standardized and accessible diagnostic protocols. Such measures are essential to promote early detection and hearing rehabilitation, thereby minimizing the communicative, educational, and social impacts of hearing loss and supporting policymakers and professionals in developing inclusive, evidence-based public health strategies.