Children identified through the NHS Newborn Hearing Screening Programme (NNHSP) who do not initially meet cochlear implant (CI) criteria represent a heterogeneous cohort with poorly defined long-term outcomes. The natural history and longitudinal audiological phenotypes of hearing loss progression in this population remain uncertain across biological and socio-environmental factors.
This regional retrospective cohort study will assess serial audiograms to phenotype longitudinal hearing trajectories over a 10-year period in children identified via NNHSP who were not initial CI candidates. Using serial audiograms, we will map individual hearing trajectories alongside data linkage across regional electronic healthcare records, socio-economic parameters, congenital cytomegalovirus status and R67 genetic results, allowing stratification into infectious, genetic and idiopathic aetiological groups.
The primary outcome will be progression to CI candidacy. Secondary analyses will evaluate age at and time to referral following attainment of eligibility, delayed or absent referral despite eligibility, and predictors of progression, including baseline audiometric severity, area-level deprivation (indices of multiple deprivation), safeguarding, ethnicity, and markers of healthcare engagement.
Funding will support secure database development to ensure confidential data handling and statistical analysis of longitudinal outcomes, given the multicentre nature of this study (estimated 12 sites).
This study will generate clinically relevant evidence to improve risk stratification and follow-up pathways for children identified through national hearing screening programmes. The lessons learnt will be identified for transferability to other parts of the countries to evaluate similarities and differences in the patient pathway.