The impact of the COVID-19 pandemic on diagnostic procedures in hearing healthcare in Brazil: time series analysis and regional inequalities COVID-19 and hearing diagnostics in Brazil

Objective This study aimed to evaluate the national and regional impact of the COVID-19 pandemic on diagnostic procedures in hearing healthcare in Brazil, highlighting temporal trends, regional disparities, and post-pandemic recovery. Methods A retrospective, descriptive, ecological time series study was conducted using publicly available data from DATASUS, the national health database maintained by the Brazilian Ministry of Health. Data from January 2009 to December 2024 were analyzed, covering audiometry, newborn hearing screening, Otoacoustic Emissions (OAE), and Auditory Brainstem Response (ABR). Interrupted Time Series (ITS) and simple regression models were applied to assess changes across three periods: pre-pandemic, pandemic, and post-pandemic. Analyses were stratified by national level, Brazil’s five regions, and the state of São Paulo. Results All major hearing diagnostic procedures experienced significant reductions at the onset of the pandemic. Audiometry volumes decreased by 18.5% nationally, with São Paulo showing the most pronounced decline (−26.3%). Newborn hearing screening remained stable during the pandemic but dropped by 15.4% in the post-pandemic period, while OAE (+31.1%) and ABR (+55.0%) eventually exceeded pre-pandemic levels. Recovery was heterogeneous: the North and Northeast showed proportionally greater rebounds, while Sao Paulo and the Central-West demonstrated limited recovery. Regional disparities were evident, with wealthier regions maintaining procedure volumes disproportionate to their population share. Conclusion The pandemic caused marked disruptions in hearing healthcare delivery in Brazil, with heterogeneous recovery across regions. Vulnerable populations, particularly children and older adults, were disproportionately affected by delayed diagnoses and rehabilitation. While teleaudiology offered a partial solution during service suspensions, its effectiveness was constrained by structural and digital inequalities. Strengthening health system resilience will require prioritizing pediatric backlogs, integrating hearing health into healthy aging strategies, and embedding auditory care within broader frameworks to ensure continuity of essential services in future crises. Level of evidence (Oxford 2011) 2b.