Background Given the critical impact of hearing impairments on both individual development and societal outcomes, particularly in the context of children’s education and health, this study conducted a retrospective analysis of hearing screening test results among first-grade students. Methods The study employed a retrospective cross-sectional design, analyzing the hearing screening test results of first-grade students (aged 6–7 years) from the Umraniye district during the 2022–2023 academic year. Data from 10,638 children with complete and comprehensive records were included in the analysis. Hearing impairment was measured non-invasively via pure tone audiometry at four frequencies (500, 1000, 2000, and 4000 Hz) at 20 dB over approximately five minutes—with failure defined as no response at any frequency in one or both ears, prompting a repeat screening within 48 h and, if still failed, referral for comprehensive evaluation. Chi-Square test (or Fisher Exact test where appropriate) was used for comparison of categorized data. A binary logistic regression model was applied to assess the effect of the independent variables on hearing screening outcomes (passed in both ears vs. failed in one or both ears), with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) reported. p < 0.05 was considered statistically significant. Results The percentage of children who passed the hearing screening test in both ears was 72.8% (n = 7,747). Potential risk factors associated with failed hearing screening in one or both ears were examined. Children who failed the screening test exhibited significantly higher rates of learning difficulties, difficulty hearing when called from another room, a history of ototoxic drug use, and a history of postnatal infections resulting in sensorineural hearing loss (p < 0.001, p < 0.001, p = 0.003, and p < 0.001, respectively). Conclusion Our findings underscore the importance of early identification and intervention for hearing loss. Future research should focus on refining surveillance and screening protocols to better detect and manage hearing impairments in at-risk pediatric populations, ensuring timely diagnosis and appropriate intervention strategies.