Is It Common For A Newborn To Fail Hearing Test

What If The Baby Is Identified As Deaf Or Hard Of Hearing

Part 1: Your Child Failed Newborn Hearing Screening. What’s Next?

Early intervention services are available for babies with hearing loss so they can receive therapy to develop communication skills. Early Hearing Detection and Intervention guidelines call for a diagnosis of hearing loss by an audiologist by 3 months and intervention to begin by 6 months.

Your state EHDI program can provide more information on how your baby will be evaluated and the types of services available. These early intervention programs are supported by the Individuals with Disabilities Education Act .

What Is An Oae Evaluation

An otoacoustic emission test measures an acoustic response that is produced by the inner ear , which in essence bounces back out of the ear in response to a sound stimulus.

  • The test is performed by placing a small probe that contains a microphone and speaker into the infant’s ear.
  • As the infant rests quietly, sounds are generated in the probe.
  • Once the cochlea processes the sound, an electrical stimulus is sent to the brainstem.
  • In addition, there is a second and separate sound that does not travel up the nerve but comes back out into the infant’s ear canal. This “byproduct” is the otoacoustic emission.
  • The emission is then recorded with the microphone probe and represented pictorially on a computer screen.
  • The audiologist can determine which sounds yielded a response/emission and the strength of those responses.
  • If there is an emission present for those sounds that are critical to speech comprehension, then the infant has “passed” the hearing screen.
  • Testing generally takes about five to eight minutes.

Hearing Screening Often Fails In C

By Amy Norton, Reuters Health

4 Min Read

NEW YORK – Newborns delivered by cesarean section may be more likely to fail their first hearing test, even if their hearing is perfectly normal, a new study suggests.

The problem arises if hearing screening tests are done within a babys first two days of life, researchers say. At that point, newborns delivered by C-section have a higher failure rate than babies born by vaginal delivery.

So to avoid needless repeat tests — and anxiety for parents — the researchers are recommending a delay in hearing tests for C-section babies.

The American Academy of Pediatrics recommends that all infants have their hearing tested before they are one month old. Thats often done before a newborn leaves the hospital, though it varies by country and hospital.

The new study looked at more than 1,600 infants born at one Israeli hospital, where all newborns have their hearing evaluated before going home.

Researchers found that when babies born by C-section had their hearing tested in their first two days of life, about 21 percent failed the test. That compared with seven percent of babies delivered vaginally — a three-fold difference.

The gap narrowed when the researchers looked at babies tested after two days: eight percent of C-section babies failed, versus one percent of vaginally delivered babies.

And in the end, all of the babies referred for further hearing tests passed, meaning that the failures had all been false alarms.

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Get The Hearing Tests Done

You will be given information before leaving the hospital, or possibly at your first appointment, as to where and when you need to go for a follow up test.

How do they test a babys hearing

The concept of checking a babys hearing seems a bit crazy. How can you test the hearing of a baby that cant tell you if they hear something or not?

Your baby actually doesnt have to do anything during the test, in fact, the less they do the better! They check a babys hearing by testing for a brainstem response. They use equipment to see if the auditory nerve is responding to various sounds of different levels of loudness and different frequencies.

What happens at the test

For the retest you will be asked to bring your baby to the test tired and hungry. Its one of the few times someone will actually request that you bring a cranky baby!

The audiologist will take you back to a quiet room and have you nurse or give a bottle to the baby and get them to sleep.

For us, they attached the little electrodes to my babys head just as we started nursing to minimize what they needed to do once she was asleep. Once she was out they put a tiny item into each of her ears.

Once you baby is fast asleep they will begin the test. It takes 5-15 minutes depending on how many frequencies they are testing. For our first test they only did a very low quiet sound. My daughter once again failed.

Can I test my babys hearing at home?

Visiting An Audiologist For Testing

Hearing tests may fail to detect common form of hearing loss

Your PCP may also refer you directly to an audiologist. An audiologist is a professional who diagnoses and treats hearing and balance problems. The audiologist will perform tests as part of the hearing evaluation, and children typically find the visit easy, painless and fun! The audiologist determines which testing activity will be most appropriate to engage your child.

In fact, children often comment that it is pretty cool to sit in a sound booth.

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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 doesnt 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.

What Causes Hearing Loss

Were not sure what causes all forms of hearing loss. Possible causes include:

Genes. Genes are parts of your bodys cells that store instructions for the way your body grows and works. Genes are passed from parents to children. Genes may play a role in about half of the cases of hearing loss in babies and children. If you or your partner has a family history of hearing loss, you may want to talk with a genetic counselor before getting pregnant. This is a person who is trained to help you understand about how genes, birth defects and other medical conditions run in families, and how they can affect your health and your babys health.

Sometimes the instructions in genes change. This is called a gene change or a mutation. Gene changes can cause two kinds of hearing loss:

  • Syndromic. The hearing loss happens with other health problems, like blindness.
  • Non-syndromic. This is when hearing loss is the only condition a baby has. About 7 in 10 mutations causing hearing loss are non-syndromic.
  • Premature birth or low birthweight. Premature birth is birth that happens too early, before 37 weeks of pregnancy. Premature babies often have more health problems at birth and later in life than babies born full term. Low birthweight is when a baby is born weighing less than 5 pounds, 8 ounces. Learn more about things you can do to help reduce your risk for premature birth.

    Infections your baby has after birth. Infections that can cause hearing loss include:

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    Hearing Loss In Children

    Hearing loss is a fairly common birth defect, affecting two to three out of 1,000 babies. But even if your baby fails the initial hearing test, it doesnt necessarily mean that a hearing loss exists. Up to 10 percent of all newborns in the U.S. fail their first hearing test, and of those, less than one percent have a permanent hearing loss follow-up screenings often come back normal. A failed hearing test can be the result of crying and fussing during the exam, or a buildup of fluid or debris in the ears.

    Does The Baby Actually Need A Screening

    Newborn Hearing Testing Screening (OAE and ABR)

    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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    How Are Newborns Screened For Hearing Loss

    Nearly every baby born in a hospital in the United States has a hearing screening before they go home. Hospitals use two types of newborn hearing screening tests:

    • Auditory brainstem response testing uses earphones to send sounds to your babys ears. Sticker sensors on your babys head detect how the hearing nerve responds to sounds.
    • Otoacoustic Emissions testing uses a tiny earphone and microphone placed in the babys ear. The earphone sends sounds to your babys ear. The microphone detects if there is a response from your babys inner ear.

    These tests are quick and painless, and your baby needs to be quiet or asleep to get accurate results.

    What Are Some Signs That A Child Has A Hearing Problem

    Without newborn hearing screening and special tests, the signs of hearing loss can be very hard to find. Sometimes babies and children seem very alert, so you think they can hear you well, but they are actually using their other senses to know what is going on around them. Or, as they get older, they learn to read your lips on their own.

    If you are concerned about or suspect a hearing problem, or if you notice any of the signs listed below, see your doctor as soon possible and ask about a hearing test.

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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 babys 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.

    My Baby Failed The Newborn Hearing Test Now What

    Pediatric Failed Hearing Test

    If your newborn fails her first hearing screening, she will be referred to a pediatric audiologist for a complete hearing evaluation. But dont be alarmed, a failed first hearing test doesnt necessarily mean theres a permanent hearing impairment.

    During birth, vernix can get trapped in the ear canal or fluid can get stuck in the middle ear. In addition, movement or crying during the test can influence the results.

    Still, its important you follow up with an audiologist for diagnostic testing to confirm hearing levels.

    If your baby passes follow-up testing and has no other risk factors for hearing loss, no treatment is necessary. Instead, your babys hearing will be routinely monitored at primary care well visits throughout childhood. If test results do indicate a hearing loss, your baby will be referred to a pediatric otolaryngologist.

    In about half the cases of hearing loss, genetics are to blame. However, infections during pregnancy or complications after birth can cause hearing impairments. In other cases, hearing loss can be associated with other underlying conditions.

    Either way, hearing problems can be overcome if theyre caught early, said Dr. Nelson. In fact, many times outcomes can be equal to a childs normal hearing peers.

    For more information or to schedule an appointment at Akron Childrens Ear, Nose and Throat Center, call 330-543-4930.

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    What Else Should I Know

    If your child is diagnosed with a hearing problem, the audiologist will work closely with doctors, speech-language therapists, and education specialists to create a treatment plan for your child.

    It also can help to meet other families of kids with hearing loss. Reach out to a local support group or ask a member of your care team about local programs where you can connect.

    You also can find more information and support online at:

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    Reimbursement And Program Funding

    Newborn hearing screening funding varies from state to state. States procure funds from fees, Medicaid, the Title V Maternal and Child Health Block Grant program, and state general revenues. The trend is to identify funding sources other than grants to ensure program continuity should grant support become unavailable. Costs associated with newborn hearing screening include those associated with the tests and those associated with program management .

    Early Periodic Screening, Diagnostic, and Treatment Program

    Through the EPSDT program, a set of services and benefits are mandated for all individuals under age 21 years who are enrolled in Medicaid. Federal rules encourage partnerships between state Medicaid and Title V agencies to ensure better access to and receipt of the full range of screening, diagnostic, and treatment services. EPSDT funds are an appropriate reimbursement source for screening and diagnostic services.

    Current Procedural Terminology Codes

    There are a number of CPT codes used to describe early hearing detection testing to a payer. Codes are defined by the payer or program. For specific instructions, see NCHAM State Contacts.

    Alexander, D., & Van Dyck, P. C. . A vision of the future of newborn screening. Pediatrics, 117, S350-S354.

    American Academy of Pediatrics. . Early Hearing Detection and Intervention . Retrieved from

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    In 1993 Only 5% Of Newborns Were Tested At Birth For Hearing Loss By 1997 94% Were Tested Before Leaving The Hospital And Today 97% Of Babies Are Screened Before They Leave The Hospital

    • Of babies who have their hearing tested, 1.6% do not pass.

    • Of those who do not pass the hearing screening, 69% are diagnosed with having hearing loss before 3 months of age.

    Today, almost all hospitals and birthing centers throughout the U.S. screen newborns for hearing loss. New parents should talk to their doctors to make sure a hearing test was performed and ask for the results. If a babys hearing was not screened it is best to speak to a pediatrician and schedule an initial hearing screening before the child is 1 month old.

    Approximately 3 out of every 1,000 children in the United States are born deaf or hard of hearing. Fortunately, early identification and intervention allows children with hearing loss to receive help during the first two years of life, a critical period for the development of speech and language skills, according to Dr. Robert Dobie, Senior Scientific Trustee, Hearing Health Foundation.

    Left undetected, hearing loss can negatively impact speech and language acquisition, academic achievement, and social and emotional development. These negative impacts can diminish and even be eliminated through early detection and intervention.

    Hospitals use two different types of newborn hearing screening tests. Both are safe and comfortable for your baby.

    Unilateral Hearing Loss Among Babies

    Newborn Hearing Screening – Boys Town National Research Hospital

    Unilateral hearing loss is actually quite common, with an estimated 1/1000 newborns identified with this condition at birth. By the time theyâre school-aged, roughly 3 in 100 children will have lost some or all of their hearing in just one ear.

    If all of the hearing in the affected ear is lost, it is often referred to as âsingle-sided deafnessâ .

    Left untreated, unilateral hearing loss can negatively impact critical communication and learning skills. Some of the more common developmental challenges include:

    • Delays in speech and language capabilities.
    • Difficulties learning new languages .
    • Stunted social or emotional maturity.
    • Behavioral and academic disabilities.

    Collectively, these impediments can hamper your babyâs overall quality of life â both in the short and long-term.

    This is why early intervention is so crucial.

    With the right treatment, itâs possible to improve your newbornâs ability to hear and communicate. This can help your baby lead a normal, productive, and happy life among his or her hearing peers.

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    Innovation Spotlight: How Ut Southwestern Faculty Affiliates Led The Texas Journey To Universal Newborn Hearing Screening

    Angela Shoup, Ph.D., is a champion for newborn hearing screening. She was Chief of the Division of Communicative and Vestibular Disorders at UT Southwestern Medical Center and is currently the Executive Director of the Callier Center for Communication Disorders at UT Dallas, a professor at UT Dallas and a clinical professor in the department of Otolaryngology at UT Southwestern.

    Evolution of Hearing Screening in Texas

    • 1960s: National advocates begin working toward universal newborn hearing screening.
    • 1970s: The Joint Committee on Infant Hearing recommends developing a high-risk registry for screening, inclusive of factors we still use today in determining a childs chances for delayed onset or progressive hearing loss, such as infections or premature birth.
    • 1986: Supported by the National Council of Jewish Women, Parkland begins newborn hearing screenings for all babies at high risk for hearing loss, as well as all babies in special care nurseries, regardless of known risk factors.
    • 1993: The National Institutes of Health recommends that all infants need an ABR or OAE hearing screening by three months of age, and that appropriate follow-up should be established for babies who do not pass.
    • 1996: Dr. Shoup joins the UT Southwestern faculty with a passion for newborn hearing and early language access.

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