Background: Early Hearing Detection and Intervention (EHDI) plays a critical role in improving language, cognitive, and socio-emotional outcomes for infants with hearing loss. In Nigeria, however, EHDI implementation remains limited by fragmented service delivery, uneven technological capacity, and sociocultural factors that delay timely diagnosis. This study explored the perspectives of paediatric audiologists and parents to provide a comprehensive understanding of the opportunities and challenges influencing early hearing care across diverse Nigerian settings.

Methods: A mixed-methods design was employed across audiology facilities selected systematically from four Nigerian geopolitical zones. Twenty-five paediatric audiologists and twenty-three parents of children with congenital hearing loss participated. Quantitative data were collected using a structured questionnaire assessing awareness, diagnostic access, and intervention experiences. Qualitative data were obtained through semi-structured interviews and two focus group discussions. Thematic analysis followed Braun and Clarke’s six-step framework, with dual coding, external auditing, and member validation to enhance credibility.

Results: Quantitative findings demonstrated broad agreement on the diagnostic value of otoacoustic emissions (OAEs) and automated auditory brainstem responses (AABRs), the developmental benefits of early intervention, and the importance of active parental involvement. However, respondents identified persistent barriers including high costs of screening and therapy, poor public awareness of early hearing loss symptoms, and a critical shortage of trained personnel, and unequal distribution of diagnostic tools, particularly in rural and northern regions. Thematic analysis further underscored disparities in diagnostic capacity, sociocultural interpretations of deafness that delay clinical consultation, and economic constraints that hinder continuity of care. While families who accessed early intervention reported improved communication, social engagement, and learning readiness in their children, systemic gaps continue to limit widespread success.

Conclusions: Despite growing technological capacity and awareness of EHDI benefits, significant structural, financial, and sociocultural challenges continue to impede timely diagnosis and intervention in Nigeria. Strengthening national policies, ensuring equitable distribution of diagnostic tools, expanding professional training, subsidising services, implementing culturally sensitive awareness campaigns and integration of Universal Newborn Hearing Screening into routine postnatal care are essential to improving outcomes for deaf infants.