Neonatal Hearing Loss: Mechanisms, Clinical Implications, and Global Perspectives

Neonatal hearing loss remains a significant global health concern, contributing substantially to long-term communication difficulties, language delays, and social impairment. Neonatal hearing loss arises from a multifactorial interplay of infectious, genetic, and acquired etiologies, each contributing distinctly to auditory impairment. Genetic factors account for a substantial proportion of sensorineural hearing loss, influencing susceptibility and severity. Congenital and perinatal infections are preventable causes that can induce cochlear injury through cytotoxicity, inflammation, ischemia, and disruption of auditory development. Acquired conditions, including hyperbilirubinemia, kernicterus, aminoglycoside and loop-diuretic ototoxicity, hypoxic-ischemic injury, and other neonatal intensive care unit-related exposures, further contribute through mechanisms involving neurotoxicity, oxidative stress, and impaired neural transmission. Understanding this broad etiological spectrum is essential for early risk identification, targeted prevention, and timely auditory intervention. Early detection through newborn hearing screening, TORCH surveillance, and pharmacogenomic approaches offers an opportunity for timely interventions that may preserve auditory and developmental outcomes. This review provides a comprehensive synthesis of the epidemiology, pathophysiology, diagnostic approaches, and evidence-based management strategies for neonatal hearing loss, with particular attention to recent advances published within the last decade.