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Newborn Screening – Hearing Screening

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1. What is newborn hearing screening?

Newborn hearing screening is a painless screen done on your newborn to check his or her hearing. Every baby should have a hearing screening completed within the first month (30 days) of the baby’s life.

Newborn screening and diagnosis helps ensure all babies who are deaf or hard of hearing are identified as soon as possible. Then, they can receive early intervention services that can make a big difference in their communication and language development. 

2. Why do some babies need another hearing test?

When a baby's newborn hearing screen is out of the normal range, your baby’s healthcare team or the state screening program will arrange for additional testing. It is important to remember that an out-of-range screening result does not necessarily mean that your child has hearing loss. Babies can fail the newborn hearing screening due to fluid in the ear, movement or crying, or noise in the testing room. However, because some babies do have hearing loss at birth, follow-up testing is the only way to know for sure if your baby does or does not have hearing loss.

3. Can a newborn pass the hearing test and still have hearing loss?

Yes. Some babies will hear well enough to pass the first hearing screen, however they may lose hearing later in infancy or adulthood due to illness, infection, injury, reaction to medications, or family history of hearing loss. If your baby has difficulty hearing or is behind in speech and language skills, discuss your concerns with your baby's doctor and ask for your child's hearing to be checked.

4. How is a hearing screen different from an audiology evaluation?

Hearing screening is a way to quickly identify potential hearing loss. Babies who do not pass their newborn hearing screening are referred to an audiologist for a complete audiology evaluation. This is the only way to know that your baby hears all the sounds needed for speech and language development.

5. Can I wait until my baby is older before I schedule follow-up testing with an audiologist?

No. Prompt follow-up, ideally between 2-4 weeks of age, will make the testing easier to perform (since newborns spend much of their time sleeping) and allow for timely diagnosis if your baby does have hearing loss.. Babies with hearing loss have better speech and language outcomes the earlier the hearing loss is detected. 

6. Why do newborns need hearing screening?

The hearing screening is a first and important step in helping understand if your baby may be deaf or hard of hearing. Without newborn hearing screening, it is hard to know when there are hearing changes in the first months and years of your baby's life.

Babies may respond to noise by startling or turning their heads toward the sound, for example, butut this doesn't necessarily mean they can hear all the sounds around them and everything we say. Babies who are deaf or hard of hearing may hear some sounds but still not hear enough to understand spoken language.

Infants who are deaf or hard of hearing need the right support, care, and early intervention services to promote healthy development. If hearing loss is not identified, it may have negative effects on the baby's communication and language skills. Longer term, a missed hearing loss can also impact the child's academic achievement and social-emotional development.

7. Why is it important that newborns get screened?

Babies learn to communicate as soon as they are born. Babies may respond to noise by expressing surprise or turning their head toward the sound, but this doesn't mean they can hear all the sounds around them. The hearing screen is the only way to determine if the baby hears at levels where consonants and vowels are produced.  If the baby cannot hear these sounds then they will not be able to produce them.  Detecting hearing loss early can decrease delays in speech, language and social skill development.

8. How is the screening done?

A baby's hearing is screened using Automated Auditory Brainstem Response (AABR), Otoacoustic Emissions (OAE), or both. Screening only takes a few minutes. In most cases, you can stay with your baby while the screening is done.

Otoacoustic Emissions (OAE)  If the part of the ear called the cochlea is normal, it produces sound in response to external stimulation, which is what is measured during the OAE test.  To measure OAEs, a small probe is placed in the infant’s ear canal and sound is presented by either one or two tiny speakers. Any response produced by the ear is recorded with a small microphone that is inside the probe.   If cochlear hearing loss exists, the cochlea either will not generate a response or it will generate a response that falls below the level that is expected from an ear with normal hearing.

Automated Auditory Brainstem Response (AABR)  The normal ear-to-brain connection creates small electrical currents when excited. AABR tests measure these electrical responses through small surface electrodes placed on the baby’s head..  An earphone is placed in the ear, brief sounds are played, and the electrical signals across the electrodes are recorded. If hearing is normal, these signals should be observed for low-level stimuli.  If hearing loss exists, these signals will only occur after higher levels of stimuli.  Compared to OAE tests, AABRs are less dependent on the status of the middle ear because the response is recorded across surface electrodes and does not have to travel back out through the middle and external ear.

9. Where can my baby get a hearing screen?

Your newborn will get a hearing screening at your birth facility. If the birth center does not do a hearing screening, they will refer you to another facility to set up your baby’s appointment. 

10. How do i know if my baby had a hearing screen?

You should be given a copy of the results before you and your baby leave the birth facility. Check discharge paperwork for hearing screening results. Contact the birth facility to find out if your baby was screened. If you have problems with the above, contact the Kansas Newborn Hearing Screening Program.

11. What if I deliver my baby at home?

Your baby can be screened by a midwife, local audiologist, or any facility that has hearing screening equipment and personnel trained to perform the screening (health department, Parents as Teachers, early intervention programs, etc.). Your baby’s doctor will provide you with a referral.

12. How much does it cost?

Most health insurances cover hearing screening and any resulting testing until the infant is 24 months (2 years) of age. Contact your health insurance provider. Keep in mind your copays and deductibles may affect your cost. 

13. What if my baby does not pass the screening?

If your baby does not pass the hearing screening at birth, it does not necessarily mean that the baby is deaf or hard of hearing. Fluid or vernix inside the baby's ear, for example, or too much noise in the room can affect results. In fact, most babies who do not pass the newborn screening have normal hearing. 

About 1 or 2 in every 100 babies will not pass the initial hearing screening at birth and will need tests with an audiologist who has experience working with babies. This testing should include a more thorough hearing and medical evaluation, and be completed as soon as possible. Be sure to talk with your baby’s doctor about scheduling further tests if your baby does not pass the hearing screening at birth.

14. If my baby is identified as deaf or hard of hearing, what are the treatment and intervention options?

The Kansas Early Hearing Detection and Intervention (EHDI) program can help provide you and your PCP with more information. Babies who are deaf or hard of hearing should be referred to Early Intervention for evaluation and services. Additionally, the Individuals with Disabilities Education Act (IDEA) supports intervention programs for children who are deaf or hard of hearing within early intervention and school programming.

The audiologist, together with the otolaryngologist, can tell you the type and degree of hearing loss your baby has and what the next steps are. These next steps can vary depending on your family's choices, as well as the type and degree of hearing change.

15. If my baby passes the newborn hearing screening, does it mean they will not have hearing loss later?

Some babies may develop hearing loss later in childhood. Causes of late onset or progressive hearing loss in children can include genetics, frequent ear infections, other infections like measles or meningitis, a head injury, exposure to damaging levels of loud noises, and secondhand smoke. Newborns who need an extended period of neonatal intensive care  should consider additional testing later in infancy as they may be at an increased risk for hearing loss later. 

Even if your baby passes the newborn hearing screening, you should still watch for possible signs of hearing loss as your child grows. Talk with your pediatrician if your child:

·         Doesn't startle at loud noises by 1 month or turn toward sounds by 3-4 months of age.

·         Doesn't notice you until they see you.

·         Concentrates on vibrating noises more than other types of sounds.

·         Doesn't seem to enjoy being read to.

·         Is slow to begin talking, hard to understand, or doesn't say single words such as "dada" or "mama" by 12 to 15 months of age.

·         Doesn't always respond when called, especially from another room.

·         Seems to hear some sounds but not others. (Some hearing loss affects only high-pitched sounds; some children have hearing loss in only one ear.)

·         Has trouble holding their head steady or is slow to sit or walk unsupported. (In some children with sensorineural hearing loss, the part of the inner ear that provides information about balance and movement of the head is also damaged.)

·         Wants the TV volume louder than other members of the family.

16. If my baby passes the first hearing test, why is more screening needed?

Even if your child shows no signs of hearing changes, the American Academy of Pediatrics recommends they be screened again at ages 4, 5, 6, 8, and 10. Additional screenings are recommended sometime between ages 11-14, 15-17, and 18-21--or any time there is a concern. More frequent follow-up screenings may be recommended for children who have a higher risk for hearing loss. Hearing loss sometimes is gradual and hard to notice at first. Routine screenings can catch hearing changes early, when providing support and resources can have the most impact on the child's development.

Remember:

Timing is everything. The soon hearing changes are identified in a baby, the more likely interventions can help her reach her full potential. Talk with your pediatrician if you have any concerns about your child's hearing.

17. What is the difference between a hearing screen and a diagnostic evaluation?

The purpose of the hearing screening is to quickly test one part of the hearing system to find out whether it is working properly. Diagnostic hearing testing uses the same methods of testing but checks more frequencies and levels. Screening take less than 10 minutes, while diagnostic testing is more detailed and takes two to three hours because all parts of the hearing system are checked. Testing is done while the baby is asleep. It may take more than one appointment to get all the testing done. Your audiologist,- a person trained to check hearing, can explain all the tests, why they are being done, and what was found.