Hearing Loss In Babies
1 to 2 babies in every 1,000 are born with permanent hearing loss in 1 or both ears.
This increases to about 1 in every 100 babies who have spent more than 48 hours in intensive care.
Most of these babies are born into families with no history of permanent hearing loss.
Permanent hearing loss can significantly affect babies’ development.
Finding out early can give these babies a better chance of developing language, speech and communication skills.
It will also help them make the most of relationships with their family or carers from an early age.
How Is The Newborn Hearing Test Done
The newborn hearing test is called the automated otoacoustic emission test. It takes just a few minutes.
A small soft-tipped earpiece is placed in your baby’s ear and gentle clicking sounds are played.
It’s not always possible to get clear responses from the 1st test. This happens with lots of babies, and does not always mean your baby has permanent hearing loss.
It could mean:
- your baby was unsettled when the test was done
- there was background noise
- your baby has fluid or a temporary blockage in their ear
In these cases, your baby will be offered a 2nd test. This may be the same as the 1st test, or another type called the automated auditory brainstem response test.
The AABR test involves placing 3 small sensors on your baby’s head and neck. Soft headphones are placed over your baby’s ears and gentle clicking sounds are played. This test takes between 5 and 15 minutes.
These tests will not harm your baby in any way.
Newborn Screening And Follow
Newborn hearing screening uses earbuds that are connected to a special device to check your babys hearing while your baby is calm and in a quiet room. The hearing screening is not painful, and many babies sleep through the few minutes needed to do the screening.
There are two ways to screen a newborn for hearing status. Your baby may have one or both screens. One screen uses a small earbud and microphone to check for echoes in response to sound made in your babys ear . Another screen uses earphones and stickers with sensors to see how your babys brain responds to sound . Your baby will get either a Pass result or a Fail result.
In hearing screening an out-of-range screening result is called a Fail result. If your babys hearing screening gives a Fail result, the person doing the hearing screen will let you know right after the screen. Together, you will discuss next steps and follow-up plans.
Some babies who have typical hearing may have a Fail hearing screening result, this is usually because they still have fluid or other buildup in their ears. A Fail result means that your baby needs more follow-up screening and possible testing.
Your baby may need the following tests after a Fail hearing screening result:
- Another hearing screen
- A more complete, full hearing test
- Genetic testing using a blood sample to look for genetic causes of hearing loss
- Testing for infections at birth that can cause hearing loss
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Retesting May Be Needed
The results of the a hearing test indicate an infant’s hearing ability at the time of the test. Some children with recurrent ear infections, serious acute or chronic illness, or with a family history of hearing impairment , or other risk factors may develop hearing loss later in life. If there are ever any concerns about a child’s hearing ability, or speech and language development, this should be addressed by the parents and the physician in order for an appropriate evaluation is to be completed.
Page last updated: June 1, 2022
Implementing Hearing Screening Protocols: Who And When
Hearing Impairment is not a visible condition at birth, and the cause of newborn hearing loss can be elusive. Most children with congenital hearing loss are born to normal hearing parents and have no health issues or risk factors for hearing loss. A Belgian study3 shows that the origin of hearing loss can only be identified in half of children referred by hearing screening. Of these, 60% of hearing loss was congenital and 19% suffered from cytomegalovirus infection. Other common factors for a high risk of hearing loss include premature birth, ototoxic medications, hyperbilirubinemia, or syndromes associated with hearing loss such as Waardenburg or neurofibromatosis.
The high prevalence of congenital hearing loss suggests, however, that even an apparently healthy baby, with no risk factors might still be susceptible to hearing deficits. Therefore, every infant even those who appear healthy in all respects should receive a newborn hearing screen. Additionally, research supports the Early Hearing Detection and Intervention guidelines4 advocating that early intervention for hearing loss is initiated no later than six months of age. Therefore, early screening at birth is strongly recommended.
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Healthy Hearing: It Means The World To Your Infant
Can You Really Test an Infant’s Hearing?
Yes, and the tests are very reliable. Arkansas is one of 43 states whose legislatures have required that every newborn receive a hearing screening before leaving the birth hospital. There are two widely used screening methods that are highly reliable and painless. One is called Otoacoustic Emissions , the other is Automated Auditory Brainstem Response . In both methods, a soft sound is played into the baby’s ear through a tiny, specially designed earphone. A machine then measures the baby’s response to the sound. In many cases, babies don’t even awaken while they are being tested.
Where The Role Can Lead
You could become a newborn screening coordinator, supervising and organising the work of a team of screeners.
You could move into other jobs in the wider healthcare team or with the appropriate qualifications for entry to university, you could apply to train as a healthcare professional, such as a midwife or nurse or as an audiologist.
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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.
Maine Newborn Hearing Program
In Maine, all hospitals with birth facilities offer newborn hearing screening before babies go home. A hearing screening is a test to tell if an infant might have a hearing loss. Hearing loss can affect a child’s ability to develop communication, language and learning. Testing is the only way to know if a baby has hearing loss.
Hearing screening is quick, easy, and does not hurt. In Maine the screening method used at birth facilities is Automated Auditory Brainstem Response or AABR. Small sensors are placed on the baby’s head and earphones are also used. Soft sounds are presented while your baby sleeps naturally.
Hearing loss is the most commonly occurring disorder in infants in the US and affects as many as 1 to 3 out of 1,000 babies born each year. Genetic factors are the cause of hearing loss in some babies, particularly those with a family history of hearing loss. Delayed detection of hearing loss can lead to communication, social, psychological, behavioral and educational challenges. The American Academy of Pediatrics recommends that all infants be screened by 1 month of age, diagnosed by 3 months of age, and receive early intervention services no later than 6 months of age.
For information please contact Anne Banger, Newborn Hearing Coordinator Tel: 287-8427
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Automated Auditory Brainstem Response
If an infant cannot get a OAE or if an infant doesnt pass the OAE, they can get a different test an automated auditory brainstem response. For this test, small sensors are put on the babys head, and the baby will wear earphones. This test measures how the nerves that control hearing respond to sound. Small sensors are placed on the babys head and earphones are also used. Both of these tests are safe and do not hurt.
Both of these test must be done at the hospital your baby was born. If your baby was born at home, your midwife needs to give you a referral to one of these birthing hospitals.
Infants And Babies Hearing Can Be Checked
Do you know that your babys hearing can be checked even before leaving the birth hospital? Many states, communities, and hospitals offer hearing screening for babies. A babys hearing can be screened using Automated Auditory Brainstem Response , Otoacoustic Emissions , or both.
Babies usually have their hearing screened while still in the hospital, either in the nursery or in their mothers room.
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How Is Hearing In Infants Tested
Hearing in infants can be tested using two different methods: the auditory brainstem response evaluations or the otoacoustic emission measures. Both tests are accurate, noninvasive, automated, and do not require any observable response from the infant.
Which test is used depends on the screening program’s choice of instrumentation and training. For a screening tool, both methods are extremely effective. There are, however, some distinct differences in how the hearing is measured using an ABR versus an OAE.
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.
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Program Evaluation And Quality Assurance
Various quality indicators and benchmarks can be used to evaluate quality assurance and performance relative to screening and diagnosis, including the following :
- The number of newborns who complete screening by 1 month of age. The benchmark is 95%.
- The number of newborns referred for diagnostic audiologic evaluation. The benchmark is 4%.
- The number of newborns who did not pass the screening and went on to have a comprehensive diagnostic audiologic evaluation by 3 months of age. The benchmark is 90%.
- The percentage of infants obtaining amplification within 1 month of hearing loss confirmation for families choosing that option. The benchmark is 95%.
Other quality assurance indicators may include
- the number of follow-up appointments scheduled and recorded
- parent/guardian satisfaction with the process
- timeliness and accuracy of screening results and
- the capacity to analyze and report data.
States can also evaluate their programs as they report the statewide findings to the CDC. CDC data collection includes the number of
- live births
- newborns passing outpatient screening and
- newborns not passing outpatient screening in one or both ears.
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.
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If An Infant Does Not Pass A Hearing Screen In The Hospital What Happens Next
Most hospital screening programs will refer infants who failed the initial screening test to a secondary center that specializes in more complete testing for diagnosis.
- Sometimes, simple problems, such as too much residual amniotic fluid and vernix in the ear canal, will resolve prior to the rescreen and the infant will pass the second test.
- The rescreen is an important step in determining whether the infant is able to hear, so it should not be taken lightly.
- If an infant does not pass the rescreen, then a full diagnostic test will be necessary.
- This test may be completed at the rescreen site or at another facility, depending on several factors.
What Does It Mean If My Baby Is Referred To A Hearing Specialist
If the screening test results do not show a clear response from 1 or both of your baby’s ears, an appointment will be made with a hearing specialist at an audiology clinic.
Even if this happens, it does not necessarily mean your baby has permanent hearing loss.
A hearing specialist should see you within 4 weeks of your baby’s hearing test.
It’s important that you attend the appointment in case your baby does have permanent hearing loss.
The appointment will usually take about 1 to 2 hours. This includes time to settle your baby.
If possible, feed your baby shortly before the hearing test. Make sure you have everything you need to keep them comfortable and happy.
The tests give more detailed information about your baby’s hearing. They will not hurt or be uncomfortable for your baby, and you’ll be able to stay with them while the tests are done.
You may want to take your partner or a friend or relative with you to the appointment.
The audiologist will usually be able to give you the results at the end of the appointment. They’ll explain what the results mean for your baby’s hearing and whether they need any more tests.
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