Background <p>Many children with hearing loss present with coexisting medical conditions. Audiologists often face significant challenges in the early identification, diagnosis, and habilitation of hearing loss in these cases. This article presents a paediatric case to highlight the specific challenges encountered and the insights gained while addressing hearing loss in the context of complex medical needs.</p> Case presentation <p>A 23-day-old infant receiving medical treatment for meningitis and other health conditions was referred for hearing screening. After a comprehensive case history, screening was conducted using otoacoustic emission (OAE) testing and behavioural observation audiometry (BOA). The diagnosis of meningitis had already established a risk for hearing loss. Absent OAE responses and BOA results further supported the suspicion of hearing loss, and thus, a diagnostic audiologic evaluation was conducted. Given the potential progression of hearing loss, audiological assessments were repeated weekly until discharge. The results demonstrated a progressive, asymmetrical sensorineural hearing loss affecting both ears. As the hearing loss had not stabilised, a follow-up evaluation was recommended 15 days post-discharge. However, the parents prioritised other medical treatments, resulting in a 3-month delay. Upon re-evaluation, the hearing loss had progressed from mild (at the initial evaluation) to severe in the right ear and from minimal to moderate in the left ear. Although a hearing aid trial was recommended, the child was subsequently lost to follow-up. The present case revealed progressive sensorineural hearing loss, delayed hearing aid trial, and loss to follow-up due to unstable medical status and competing health priorities. Delays in audiological management can be linked to family and social barriers. Although in this case, early referral was achieved through team awareness, the intervention was ultimately postponed due to comorbidities. The case highlights the need for multidisciplinary coordination and flexible, individualised management protocols.</p> Conclusion <p>Children with hearing loss and comorbid medical conditions face significant risks of delayed identification and intervention. Interdisciplinary collaboration, robust follow-up systems, and caregiver education are essential to improving outcomes. When timely intervention is not feasible, early introduction of sign language alongside spoken language may support language development. Ongoing research and tailored protocols are needed to address the complex care needs of this population.</p>