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ABSTRACT Objectives We aimed to evaluate the long‐term auditory outcomes of early antiviral therapy with valganciclovir (VGCV) in children with congenital cytomegalovirus (cCMV) infection, regardless of initial symptomatology. Methods This retrospective cohort study included 56 pediatric patients (112 ears) diagnosed with cCMV infection between 2004 and 2022 at our institution. The participants were divided into those who received (treated group, n = 19) and did not receive (untreated group, n = 37) VGCV or ganciclovir therapy. Audiological assessments were conducted over a minimum 2‐year follow‐up period (range, 2–15 years). Furthermore, hearing thresholds were evaluated longitudinally, with a decline of ≥ 10 dB being defined as significant. The primary outcomes were hearing loss progression and age at onset. Results At the final follow‐up, there were no significant between‐group differences in the prevalence or severity of hearing loss. However, fewer ears showed significant hearing deterioration in the treated group (26%) than in the untreated group (41%, p < 0.01). Furthermore, the magnitude of hearing decline was smaller in the treated group (35.0 ± 13.8 dB) than in the untreated group (67.4 ± 19.2 dB) ( p < 0.002). Hearing loss in treated patients stabilized by the age of 3 years; in contrast, untreated patients experienced multiple deterioration episodes even after this age. Conclusions Early VGCV treatment may help stabilize hearing and reduce long‐term hearing deterioration in children with cCMV infections. This highlights the importance of early intervention and hearing surveillance, especially in untreated individuals. Level of Evidence 4