Introduction Hearing impairment is frequent in patients with end-stage renal disease (ESRD). We aimed to assess the prevalence of hearing impairment in children on regular hemodialysis and renal transplantation. Materials and Methods Transient-evoked otoacoustic emissions (TEOAEs) has been done for 80 children on regular hemodialysis and 40 with renal transplant. Results In hemodialysis group, TEOAEs showed that 53.8% children had hearing affection, it was significantly related to dialysis duration, dialysis adequacy, vascular access infection, hepatitis C virus (HCV) infection, and ototoxic drugs (p = 0.001, 0.037, 0.011, 0.004, 0.030, 0.007, and 0.044, respectively). In renal transplant group hearing impairment was 25%. There was significant relation with period of dialysis before transplantation and biopsy proved rejection (p = 0.008, <0.001, respectively). Conclusion Hearing impairment is a common finding in ESRD patients. Thus audiological assessment must be done in these patients.