The Components Of An Effective Ehdi Program:
- Screening of All Newborns
- Identification of Babies with Permanent Hearing Loss
- Intervention Services
- Family Support
- Documentation, Monitoring and Ongoing Evaluation of the Program
Ongoing monitoring and evaluation of any screening program are critical to the continuing success of that program. Canada is considered to have some of the best UNHS programs globally, however, as each province and territory is responsible for developing and running its own programs, areas for improvement can be found. In 2019, a task force was created to evaluate the hearing screening programs in Canada using a report card. The overall grade of insufficient was awarded nationally. While some regions improved, others did not change, while some even declined in meeting all of the components listed above. This highlights the important role that ongoing evaluation plays, and that even in developed countries there is room for improvement.
Regardless of the type of EHDI program implemented it is critical that infants who fail the screening be seen by Audiology for a full assessment. Early identification and intervention of hearing loss have been shown to lead to better outcomes in a childs speech and language development, education, psychosocial and economic development. EHDI programs can also lessen the stress on families and provide genetic counselling, if relevant, should the parents want to have additional children.
What Do The Results Mean
If the hearing screening shows a clear response from both of your babys ears, its unlikely that your baby has hearing loss.
Some babies need to have a second test to achieve a clear result. A refer result requires the hearing screen to be repeated within a few weeks. It doesnt necessarily mean that your baby has a hearing problem.
The initial screen result can be affected by:
- fluid or other substances that have got into the ear canal during birth
- temporary middle ear fluid
- the area where the screen takes place is too noisy, or your baby is too restless
It is very hard to tell how well a young baby can hear by watching their behaviour so it is important that the hearing screen is repeated.
If your baby doesnt pass the second hearing test, they will be referred to a paediatric audiologist to test if they have a hearing problem.
The audiologist will see your baby as soon as possible if they do not pass the follow-up hearing screen in both ears. If your baby passes the hearing screen in only 1 ear, the audiologist will see your baby at about 2 to 3 months of age, or sooner if possible.
The audiologist will do a full hearing assessment. If there is a hearing problem, the tests will also show whether it’s likely to be temporary or permanent and your child will receive appropriate treatment and support.
What Should I Do If My Babys Hearing Screening Reveals Potential Hearing Loss
If the results show that your baby may have hearing loss, make an appointment with a pediatric audiologista hearing expert who specializes in the assessment and management of children with hearing loss. This follow-up exam should be done as soon as possible, ideally by the time the baby is 2 to 3 months old. The audiologist will conduct tests to determine whether your baby has a hearing problem and, if so, the type and extent of that problem.
If you need help finding a pediatric audiologist, ask your pediatrician or the hospital staff who conducted your babys screening. They may even be able to help you schedule an appointment. You can also try the directories provided by the American Academy of Audiology or the American SpeechLanguageHearing Association. If the follow-up examination confirms that your baby has hearing loss, he or she should begin receiving intervention services as soon as possible, ideally by the age of 3 to 6 months. See our Babys hearing screening and next steps: Timeline for parents for a guide to follow.
The pediatric audiologist may recommend that your baby visit a pediatric ear, nose, and throat physician who specializes in conditions affecting the ear, known as a pediatric otologist. A pediatric otologist can determine possible causes of hearing loss and recommend intervention options. If your child has siblings, the audiologist or otologist may also recommend that their hearing be tested.
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About The Hearing Screen
Screening a babys hearing accurately requires special training and equipment.
The screen is reliable, quick and give results right away. It measures the ears or brains response to soft sounds played in your babys ear and, if needed, may use small stickers placed on your babys head.
The technology used for the hearing screen is safe and will not hurt your baby.
What Other Kinds Of Hearing Tests Can Babies Have
If your baby doesnt pass his ABR or OAE test in newborn screening, her provider refers her to an audiologist. This is a person with special training to diagnose and treat hearing loss in newborns, children and adults. Your childs provider also may refer your baby to an otolaryngologist . This is a doctor with special training in ear, nose and throat care.
An audiologist gives your baby a full hearing test to check for hearing loss. This can include the ABR and OAE tests, as well as other hearing tests. The audiologist also may use a behavioral audiometry evaluation to check how all parts of your babys ear work. For this test, the audiologist sees how your baby responds to sound by watching for changes in behavior. Your baby has to be awake for this test. The audiologist plays a sound and checks to see if your baby reacts. For example, your babys eyes may move or your baby may turn her head, suck on a pacifier, get quiet or seem to be listening for the sound. If your baby responds to the sound, the audiologist gives your baby a reward, like a toy with flashing lights. This is called visual reinforcement audiometry.
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Hearing Tests For Infants And Children
Children start learning language from the moment they are born. Babies who hear well learn a lot about their world through all of the sounds around them. If your child cannot hear well, they will likely have trouble learning language, learning to talk and learning to read.
Hearing also plays an important role in a childs social and emotional development. It is important to recognize the signs of hearing loss early so that children can receive any supports they need to be successful.
How Can I Help My Child With Hearing Loss Develop Language Skills
When interventions begin early, children with hearing loss can develop language skills that help them communicate freely and learn actively. The Individuals with Disabilities Education Act ensures that all children with disabilities have access to the services they need to get a good education. Your community may also offer additional services to help support your child.
Your babys health care team will help you find services and methods to overcome communication barriers. You may also be referred to a speech-language pathologist or a teacher who is experienced in working with children with hearing loss. Talk to and communicate with your child often and stay up-to-date with all health care appointments.
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How Newborn Hearing Screening Works
Babies can cry a lot during routine medical procedures, but rest assured, newborn hearing screenings are safe and comfortable. Many infants sleep through the entire procedure, which usually only takes a few minutes.
Heres a quick description of the two most common tests your newborn may experience:
- Otoacoustic emissions measures your babys response to sound by placing a miniature earphone and microphone in the ear. Normal hearing triggers an echo into the ear canal, which is measured by the microphone. If your baby has hearing loss, no echo is recorded. The screening is done on each ear and a passing result confirms that the infants inner ears are receiving sounds.
- Auditory brainstem response measures how the auditory nerve responds to sound through small electrodes placed on your babys head. This screening is a more complete test of the auditory system, and it requires small electrodes to be taped to the baby’s scalp. The screening is again done for each ear and a passing result confirms that the infants brain is receiving sound.
Your baby may have both tests together, one at a time, or the ABR only if they fail the OAE. Hospitals determine which tests they use based on costs, personnel and the number of babies born.
If My Baby Seems To Hear Normally Can The Tests Be Wrong
Parent assessment of child hearing is not always accurate, so it is important to have the childs hearing professionally tested. Just because a baby reacts to sounds does not mean the child has full range of hearing a baby may hear certain sounds but not others. Only a professional hearing test that checks each ear separately can accurately tell how your child hears.
Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline : otitis media with effusion. Otolaryngol Head Neck Surg. 2016 154:215-225.
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Why Is It Important To Have My Babys Hearing Screened Early
The most important time for a child to learn language is in the first 3 years of life, when the brain is developing and maturing. In fact, children with typical hearing begin learning speech and language in the first 6 months of life. This is why it is so important to screen and start interventions for hearing loss as early as possible. Research shows that children with hearing loss who get help early develop better language skills than those who dont.
What If The Baby Doesnt Pass The Initial Screening
Roughly one to two of every 100 newborns will fail the initial hearing screening tests.
While thats concerning, keep in mind that failing a test doesnt necessarily mean a baby has hearing loss. It could be that the baby has excess fluid in the middle or inner ear from the birth process, which can impact screening results.
If a baby fails the initial screenings, theyll probably be given a repeat AABR test within two weeks at an outpatient facility.
If a baby passes that test, the healthcare provider will give you speech milestones to watch for at certain ages . If the baby isnt reaching those milestones, contact a pediatrician.
If the baby fails this follow-up test, theyll likely be referred to a pediatric audiologist for additional testing.
They might also be referred to an otolaryngologist to determine if there are any structural problems with the babys ear.
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What Causes Babies To Fail Their Hearing Screening
Deafness and hearing loss can be caused by genetic abnormalities, birth defects, or maternal infections during pregnancy. In some cases, the baby will immediately show signs of hearing loss, such as not responding to sounds or failing their hearing screening.
Rarely, a baby who can hear and process sound might nonetheless fail their newborn hearing screening. Some of these include babies who:
If your baby experienced these issues and passed their newborn hearing screening, they still will likely need follow-up screenings throughout childhood. Hearing loss can develop over time, and your baby may need close monitoring and screening for hearing loss through young adulthood.
If the baby did not pass the newborn hearing screening, its important that the baby receive an advanced follow-up screening within 10-12 days for the best chance at receiving early intervention and unlocking their early language development.
What Should I Know About The Newborn Hearing Screening
- Hearing screenings are fast, safe, and painless.
- Sometimes newborns are screened once or twice.
- Hearing screenings take about 10 minutes.
- Most babies sleep through the hearing screening. If your baby is noisy or restless during screening this can influence the results.
- You will receive the hearing screening results before you leave the hospital.
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How The Test Is Done
The newborn hearing screening test checks your baby’s inner ear . When a healthy ear receives sound, the inner part produces an echo. Recording this tells us that the hearing is satisfactory.
This screening test can be repeated if a clear response is not achieved in either one or both ears.
Does The Baby Actually Need A Screening
Yes, all newborns should be screened for hearing loss. In 2019, for example, 98% of U.S. newborns were screened, and 6,000 were identified with permanent hearing loss.
Experts point out that hearing loss can be an invisible condition in newbornsand approximately 95% of babies born deaf have parents with normal hearing. Identifying and addressing a babys hearing loss early in life helps their language and speech development.
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Is There Anything I Can Do To Help Develop My Baby’s Hearing
- Talk and read to her. Simply talking to your baby about what you’re doing helps to whet her appetite for learning. If you’re packing her diaper bag, give her a vivid description of what you’re including. When you dress your baby, name the colour and type of garment you’re slipping over her head. When you’re talking to her, turn off the radio or TV, so that she can hear your voice on its own.
- Tune into what your baby hears and comment on it. Whether it’s the hum of an airplane engine or the purr of a cat, noticing what your baby is listening to will be rewarding for you both.
- Pop in a CD or turn on the radio. Babies love music, so point out the tinkling of the piano and the clashing of the cymbals.
About The Infant Hearing Program
Hearing loss can develop during early childhood. It is important to pay close attention to your babys speech and language development as any issues may be a sign of hearing loss.
It is important to detect hearing loss as early as possible.
The Infant Hearing Program provides:
- hearing screening for all newborns in hospital or community settings
- assessments to identify permanent hearing loss
- monitoring of children at risk of developing hearing loss
- language development services
Two out of 1,000 babies have hearing loss at birth. Two more out of 1,000 develop hearing loss by the age of five. These children may hear some sounds but miss others, making it harder to learn speech and language. This can lead to behavioral and learning challenges.
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What If I Decline To Have The Test
Parents may refuse to provide consent for their newborns hearing screening. This will be recorded in your childs Personal Health Record. You will also be asked to sign a form confirming that when the screen was offered you declined.
You should still get information about the screen and why its important even if you choose not to have your baby screened.
If you are concerned about your childs hearing or speech and language development in the future, please arrange to have your childs hearing tested. Ask your family doctor for a referral to an appropriate service for your childs hearing to be tested. Hearing can be tested at any age.
What Can Affect My Baby’s Hearing
- Exposure to prolonged, high-decibel noise such as that found near airport runways or at rock concerts
- Serious complications during birth that may have prevented enough oxygen reaching the baby
- Low Apgar scores
- Exposure during pregnancy to infections such as rubella
- A family history of hearing problems
- Premature birth or low birth weight
- A head injury
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How Are Hearing Problems Diagnosed
There are a few ways to detect hearing loss very early in life. The oto-acoustic emission test is the most common one . A specialist will put a small microphone in your babys ear, which sends a sound. The echo that comes back is sent to a portable computer. The computer can tell whether the baby heard the sound. The test, which takes 10 to 15 minutes, can often be done before your newborn baby leaves the hospital or at a designated hearing screening unit after leaving the hospital.
The Canadian Paediatric Society recommends that all newborns have their hearing tested. Many Canadian provinces and territories have universal newborn hearing screening programsmeaning all babies are tested at birth. Families of babies who screen positive should follow up with a full hearing evaluation.
If Your Baby Is Not Offered The Screening Test
In rare cases, we do not screen some babies for hearing loss at birth.
Your baby may not be offered the screening if he or she:
- was born with congenital atresia
- suspected or confirmed bacterial meningitis
- spent more than 6 months in the special care baby unit and is not well enough to be screened
- is receiving end-of-life care
In most of these cases your baby will instead be referred to audiology services for a diagnostic hearing test.
If your baby is receiving end-of-life care, a decision will be made with you on a case-by-case basis.
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