Have You Heard About Hearing Screening?


Hearing screening is both part of Newborn Screening and is one of many Early Hearing Detection and Intervention (EHDI) programs that tries to identify anyone with hearing loss as soon as possible in order to prevent further loss of hearing and assist the child in his or her development.



Did you know that one to three out of every 1,000 children are born with some degree of permanent hearing loss? This is known as congenital hearing loss, and it is one of the many conditions tested for during a process called Newborn Screening. Nearly every child in the United States goes through newborn screening, but the amount and type of screenings varies from state to state. There are a few different steps to Newborn Screening and the hearing screening is only one of those.



Hearing screening is both part of Newborn Screening and is one of many Early Hearing Detection and Intervention (EHDI) programs that tries to identify anyone with hearing loss as soon as possible in order to prevent further loss of hearing and assist the child in his or her development. There are two different tests that can be used for the newborn hearing screen: the otoacoustic emissions test (OAE) and the auditory brain stem response test (ABR).


Depending on where a child is born, he or she will receive one or the other. The process varies slightly depending on the test, but each one takes about five to 10 minutes and is generally done while the child is sleeping. The OAE determines if certain parts of the baby’s ear responds to sound. During the test, a small earphone and microphone are placed in the baby’s ear and sounds are played. If the baby’s hearing is normal, an echo will be reflected back into the ear canal, and measured by the microphone. If

no echo occurs, this may mean the baby has hearing loss and he or she will undergo further testing.


The ABR evaluates the auditory brain stem (part of the nerve that carries sound from the ear to the brain) and the brain’s response to sound. Similarly to the OAE, small earphones are placed in the baby’s

ear and small electrodes are placed on the head to detect the brain’s response to sounds. If the baby’s brain does not consistently respond to the sounds, then he or she may have a hearing problem and will need to undergo further testing.



If the results of the hearing screen are out of the normal range or inconclusive, your baby will need to go through at least one more round of testing to receive a diagnosis. There are many reasons that a baby may fail the first screen, but have completely normal hearing and pass the follow up test. For example, vernix (a waxy substance) or fluid may be in the ear at the time of the test and alter the results. About

two to 10 percent of babies fail their first hearing screen in the U.S., but very few of them actually have or develop any kind of hearing loss. Regardless, scheduling and attending your baby’s follow-up testing is important to know for sure if your baby has, or will develop hearing loss.


All babies who fail the first test will be directed to an audiologist to examine the ears more closely. The baby will undergo a complete audiology evaluation made up of a few different tests to more fully examine the baby’s hearing. The audiologist may use the ABR or OAE in addition to other tests. These tests will not only indicate if the baby has hearing loss, but also the type and the severity.


If hearing loss is detected at this point, the audiologist will work with the pediatrician to find the best interventions and treatment options for the child as he or she develops. The audiologist may also recommend that the baby go through a genetic evaluation to determine the cause for his or her hearing loss. It is important to note that even if your baby does pass the first test, he or she may develop hearing loss over the next few months. The National Center for Hearing and Assessment management at Utah State University (NCHAM) has created an easy-to follow roadmap and checklist for families



Even if your baby passes the first hearing screen, you should monitor his or her development and take note of anything that may indicate a problem. Some warning signs that your baby may have hearing

loss include:

  • He/she doesn’t startle at loud noises
  • He/she doesn’t turn to the source of a sound
  • He/she doesn’t speak by one year of age
  • He/she doesn’t turn when you say his/her name
  • He/she seems to hear some noises, but not others


Early detection is critical for your baby’s development, so if you notice any of these signs or otherwise worry about your child’s hearing, you should contact his or her pediatrician immediately to schedule another screen or examination. If the diagnosis is made early enough, the language development (spoken or signed) of a child with hearing loss can be on par with his or her hearing peers.



Treating and managing hearing loss varies from person to person depending on when the diagnosis was made, the type and severity of the hearing loss, and the cause, which can be genetic or environmental.

One of the biggest parts of managing hearing loss is regular follow-ups as well as close monitoring of the child’s hearing as he or she develops, because his or her hearing will likely change. Although there isn’t a cure for hearing loss, there are many options to utilize the hearing that your child does have, or to communicate in other ways. Every state has different resources for early intervention programs, which can be found here: http://ectacenter.org/contact/ptccoord.asp.


Many interventions have common themes including technology and communication options. Depending on the severity of your child’s hearing loss, technology may be able to help him or her hear or hear better. Devices such as hearing aids, cochlear implants, and others may be helpful. Communication is very important for a child’s development and is necessary for him or her to thrive as he or she grows

older, but it may be hard for children with hearing loss. Sign language is an option, but it isn’t the only option for individuals who are hard of hearing or hearing impaired. In addition to sign language, methods such as auditory oral, auditory verbal, and cued speech should be considered for your child. For more information on these methods, you can visit these and other organizations’ websites: Handspeak, Oberkotter Foundation, Alexander Graham Bell Association, and National Cued Speech



To find out more about the entire process of Newborn Screening you can go to http://www.babysfirsttest.org.



Jessica Handy is a current student and intern at Genetic Alliance, focusing on creating and disseminating

family friendly materials around genetics and health to communities.


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