How To Test Hearing In Newborns

What Does The Screening Involve

How do you test a newborns hearing?

A trained hearing screener carries out the hearing screening test. Two main tests are done to screen a newborn:

ABR The tester attaches leads to your baby’s forehead, back of their neck and behind their shoulder, using sticky pads. Small earphone ‘cups’ are then placed over the baby’s ears. The earphones make soft clicking sounds and the leads measure the response from your baby’s ears.

OAE A small soft-tipped earpiece is placed in the outer part of your baby’s ear, which sends clicking sounds down the ear. When an ear receives sound, the inner part, known as the cochlea, usually produces an echo. The screening equipment can pick up a response.

These tests only take a few minutes and do not hurt your baby. The hearing screening test will usually be done while your baby is asleep or settled. You can stay with your baby while the screening test is done.

Why Should I Have My Babys Hearing Screened

Hearing screening is strongly recommended by the Ministry of Health for all newborn babies. Finding a hearing loss early and providing appropriate support helps give a baby the best chance with language, learning and social development.

The screening programme aims to screen all babies by one month of age. About one or two babies out of every 1000 born will have a significant permanent hearing loss.

Newborn hearing screening is now routine for all babies in many countries.

Prior to newborn hearing screening, hearing loss was detected very late on average it was three to four years before many hearing losses were confirmed.

Does A Refer Mean The Child Has Hearing Loss

Not necessarily. About 90% of newborns who fail their initial screening will go on to pass subsequent testing. However, follow-up testing is critical, because up to 10% of those initial referrals may have true congenital hearing loss and need treatment.

Vernix or fluid in the ear canal or fluid in the middle ear may cause an ear to “REFER.” Delaying the screening until near the time of discharge allows more time for the body to clear this fluid/debris and decreases the false positive rate. An interesting example of this phenomena is the fact that our audiologists note a higher “REFER” rate on the left than on the right, thought to be due to the fact that our newborns are usually placed in an open crib with their head rotated to the right side. This puts the left ear up, giving less opportunity for it to drain.

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What Language And Communication Approaches Might Be Available For My Child

Children who are deaf or hard-of-hearing can learn to communicate in several ways. Find out as much as you can about the communication choices and ask your health care team to refer you to experts if you want to know more. Because language development begins early, regardless of the communication mode you choose, you should engage with your child and begin intervention as soon as possible.

Common approaches used to help children with hearing loss communicate and interact with others include:

  • Listening and spoken language : works to strengthen listening, talking, and reading skills through the use of natural hearing and hearing devices such as hearing aids and cochlear implants, without the use of manual communication.
  • Auditory-oral: emphasizes residual natural hearing in combination with amplification devices and technology to help children develop speech and spoken-language skills. It includes the use of speech reading and natural gestures in the communication process.
  • Cued speech: is a system of specific hand shapes and placements that represent groups of consonants and vowels and that are used in combination with natural lip movements.
  • American Sign Language: is a visual-manual, natural language that is used in the American Deaf community.
  • Combined approaches: use aspects of various communication approaches, some of which are listed above, to expose children who are deaf or hard-of-hearing to many ways to communicate with others.

Hearing Test For The Infant

Testing your childs hearing

In addition to the above mentioned tests, a hearing test of the infant may include:

  • A simple behavioural audiometry test that includes the use of hand-held sound stimuli representing various frequency ranges . This test is used to observe the infant’s behaviour in response to certain sounds.
  • Sound field testing with visual reinforcement during which the infant is exposed to a variety of sounds through loudspeakers. The infant is trained to turn towards any sound source. When responding, the child is rewarded through an entertaining visual image or toy.

If the infant does not pass these tests a referral for an evaluation by an audiologist is needed.

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Hearing Test For The Newborn

Hearing screening of newborns before they leave the hospital or maternity ward is becoming a common practise. It is important that the child’s hearing loss is diagnosed before 3 months of age. A baby with a hearing loss present at birth should start treatment before the age of 6 months, which is an important time for speech and language development. Children whose hearing loss is identified early and who receive early intervention are found to function at the level of their peers by the time they enter school.There are two primary screening tests for newborns. Both tests are painless, take only a few minutes, and are best done while the baby is sleeping.

  • An Otoacoustic Emission test , in which a tiny microphone is placed in the baby’s ear. Sounds are transmitted into the ear, and the sounds that are emitted by the cochlea are recorded in the ear canal. Thresholds at certain frequencies can be determined by analysing the emissions. If the baby has a hearing loss there will be no emission of sound.
  • An Auditory Brainstem Response test, which uses electrodes placed at several locations on the baby’s head and ear. While the baby is resting an acoustic stimulus is presented to each ear either through headphones or insert-earphones. An analysis of the activity in the brain reveals the thresholds of hearing.

A baby that does not pass the screening tests should be re-screened to confirm results and receive an in-depth evaluation by an audiologist.

What Are The Treatment Options For Hearing Loss In Newborns

There are plenty of options for the treatment of children who suffer from hearing loss. Specialists, like the Early Intervention Specialists, work exclusively with children who have hearing disabilities. Their guidance helps kids overcome communication barriers by identifying their weak points and strengthening them. This treatment is more developmental than medical. Paediatric Audiologists are those who look into the medical aspects of hearing loss in children and may recommend hearing aids or, in some cases, corrective surgery.

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What Passing Or Failing The Test Means

Newborn hearing screenings are powerful tools to identify potential hearing loss that could impact a childs language development as they grow. But theyre also snapshots in time.

In other words, passing a newborn hearing test doesnt mean your child will never experience hearing loss. And conversely, failing an initial hearing test doesnt mean your child has permanent hearing loss.

To pass a test, your newborn must clear the screening in both ears. If your baby only passes in one ear, that test is considered failed and theyll need to be rescreened. If your baby fails the first test but passes the rescreen and doesnt have risk factors for hearing loss, this counts as a pass and they wont need more screening.

Being able to hear is important no parent wants to learn their bundle of joy didnt pass a health screening. But just like with other diagnostic tools, its possible to have a false negative with newborn hearing tests.

According to Boys Town National Research Hospital, roughly 2 to 10 percent of all newborns in the United States wont pass their first hearing screening. But of those who fail, less than 1 percent go on to be diagnosed with lasting hearing loss. So, what gives?

And in some cases, your baby might have been awake during the hearing test. Its possible they were moving too much, crying, screaming, or fussing which means the test results could be inaccurate.

What Is Newborn Infant Hearing Screening

Newborn Hearing Testing Screening (OAE and ABR)
  • Newborn infant hearing screening programs are designed to identify hearing loss in infants shortly after birth.
  • All states have implemented these screening protocols within hospitals and birthing clinics.
  • Most hearing screening tests are done prior to discharge from the hospital or birthing clinics.
  • Typically, nurses or medical assistants are trained extensively on how to operate automated equipment for testing infants. Prior to discharge, each newborn has his/her hearing tested. If, for some reason, the newborn does not pass the screen, a rescreen is usually done. If the infant does not pass the second hearing test, he/she is referred to a specialist for further testing.
  • Specialists who are experts at testing hearing are called audiologists. Audiologists have had training that emphasizes diagnostic hearing testing techniques as well as hearing rehabilitation of children and adults. Their postgraduate academic training requires a minimum of a master’s degree.

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Why Are Newborn Hearing Screening Tests Important

Hearing loss can have serious repercussions on the babys development. It inhibits the child from learning how to speak. Newborns learn from the environment around them. While babies with hearing problems can learn visually, they will be unable to pick up speech as they cannot decipher the sounds around them. A conversation initiated by the mother may sound like nothing more than muffled noises. This eventually results in impaired speech.

A hearing test can catch this impaired hearing, and the child can be sent for speech therapy. According to audiologists, children treated for hearing loss in time will never have difficulties in speech, language skills, reading and writing.

As informed earlier, hearing test for infants includes the Otoacoustic Emission Test and the Automated Auditory Brainstem Response Test . The type of test that is performed largely depends on the hospital. Some hospitals perform both tests, which is more thorough but could be more expensive. Others first screen for OAE, and only if the newborn fails this test do they perform an AABR test.

Failed Hearing Test Follow Up Is Key

A significant number of infants fail their first hearing screening due to fluid that may still be present in the ear canal right after birth. If your infant doesn’t pass the initial hearing screening, schedule a follow-up screening with a pediatric audiologist within a couple of weeks. The majority of infants will pass the second screening quite easily. For those who do not pass the second newborn screening, a diagnostic hearing test from your pediatric audiologist will investigate further.

If your infant fails their newborn hearing screening, its important to follow up as soon as possible to determine whether or not they have hearing loss and, if so, when to begin treatment or services. Experts encourage parents to meet with an audiologist who specializes in infants, a pediatric ear, nose and throat doctor , and a pediatric eye doctor since some babies with hearing loss also have problems with their vision. You may also want to meet with a geneticist to determine if your babys hearing loss is hereditary.

Most likely, your pediatrician can recommend a hearing healthcare professional who specializes in children.

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Oaes And Abrs Is One Test Better Than The Other

Both tests have advantages and disadvantages when used for screening, and depending on the program and experience of the audiologist, either one can be utilized successfully.

  • The OAE is easy and cost-effective. However, the false-positive rate may be higher for an OAE than for an ABR.
  • The false-positive rate for ABR testing is approximately 4% when testing is done during the first three days of life.
  • The false positive rate for OAE testing is 5%-21% for testing done during the first three days of life.
  • This large variation between ABR and OAE testing is commonly felt to reflect the OAE testing device’s increased sensitivity to residual amniotic fluid and vernix that is commonly found in the neonate’s ear canal.

The two tests, however, rely on different mechanisms of hearing for the screening. For in-depth testing and a complete hearing evaluation of infants, these tests work best together as a complement to each other.

When Is The Newborn Hearing Test Done

7 years of newborn hearing screening data

If you give birth in hospital, you may be offered a newborn hearing test for your baby before you’re discharged.

Otherwise it will be done by a healthcare professional, healthcare assistant or health visitor within the first few weeks.

You’ll be contacted by your local newborn hearing screening service to arrange a suitable time and venue.

Ideally, the test is done in the first 4 to 5 weeks, but it can be done at up to 3 months of age.

If you’re not offered a screening test, ask your health visitor, local audiology department or GP to arrange an appointment, or contact your local newborn hearing screening service.

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What If The Follow

Getting a passing screen in a follow-up exam can help ease your mind. Just remember that depending on your family history or any other underlying conditions that could impact your babys hearing, it doesnt mean you no longer have to focus on potential hearing loss.

While AABR and OAE tests are considered the standard and most effective options for newborn hearing screenings, theyre not 100 percent perfect. Its possible for some tones to be missed by the test. This would mean your baby could potentially have partial hearing loss.

And if you have a family history of hearing loss, your babys doctor or audiologist will generally recommend continued hearing monitoring. This is proactive designed to prevent any hearing deficiencies from delaying your babys developmental journey.

Even if you dont have any family history or known hearing concerns, your child should continue to have their hearing periodically checked.

When Should My Baby Have A Hearing Test

Most babies are screened before they leave hospital for the first time. If this doesnt happen, ask your midwife or family doctor to help organise a screening for your baby. Ideally, this should be done before your baby is 1month old.

In New Zealand, the programme is provided free of charge for eligible babies.

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Bc Specific Information Message

Hearing loss is the reduced ability to hear sounds. It can occur at any age and can be a gradual or sudden loss. Hearing loss can have many causes. The part of the ear involved determines the type of hearing loss. Depending on the cause, hearing loss can be mild or severe, temporary or permanent. For more information on hearing loss, see HealthLinkBC File #71a Hearing Loss in Children, and HealthLinkBC File #71c Hearing Loss in Adults. For more information on hearing tests for infants and children, see HealthLinkBC File #71b Hearing Tests for Infants and Children.

If you or your child is experiencing hearing loss symptoms or have questions about hearing loss, you can call 8-1-1 to speak with a registered nurse for advice anytime of the day or night, any day of the year.

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