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Newborn Hearing Screening

  • Why Newborn Hearing  Screening?

  • How early should I have my baby’s hearing screened?

  • How is Hearing screening in newborn done?

  • What are the advantages of OAE screening?

  • What does ‘REFER’ or ‘FAIL’ mean?

  • What is the Hearing Screening Protocol at Audicco Gliriaa?

  • What are some of the warning signs of hearing loss in an infant?

Why Newborn Hearing  Screening?

Newborn babies learn to recognize the familiar sounds in their home in their first few months of life.  Baby if can’t hear the sound, can’t speak, profound hearing loss can lead to dumbness.  Even partial Hearing loss in children can impair normal development of speech & language, his emotional balance, academic & intellectual skills and it affects individual for the rest of his life.

Subjective methods, such as ringing bells and hand clapping have not proven to be reliable for screening. Prior to Objective hearing tests such as OAE, infants with hearing loss typically remained unidentified until 2 ½ years of age. – far too late for optimal language development.

How early should I have my baby’s hearing screened?

  Your baby should have a hearing screening at birth or within the first month of life. If hearing loss is confirmed, it’s important to consider the use of hearing Aids or Cochlear Implant by 6 months of age. Hearing should be tested as child grows at any time on slightest suspicion of hearing deficit by Parents, care givers, teachers and family doctors.

How is Hearing screening in newborn done?

The procedure is performed with a portable hand held screening unit.

OAE screening–A small probe is placed in the child’s ear canal. This probe delivers a low-volume sound stimulus into the ear.

Tone or click stimuli are delivered, which travels from middle ear to inner ear where OAE is generated by the outer hair cells of the cochlea. This travels back and is measured with a microphone.

In approximately 30 seconds, the result is displayed on the screening unit as a “pass” or “refer.”


Automated ABR screening – Disposable surface electrodes are placed high on the forehead, on the mastoid, and on the nape of the neck.

The click stimulus (usually set at 35 dB hearing level [HL]) is delivered to the infant’s ear via small disposable earphones designed to attenuate background noise.

As with OAE screening, the sound travels through the outer, middle, and inner ear. However, in ABR, the sound continues along the eighth nerve to the brain.

An electrical response from that nerve is picked up by electrodes strategically placed on the infant’s head. This response is recorded and analyzed.

However, it lacks frequency-specific information and requires increased preparation time prior to testing.

What are the advantages of OAE screening?

Handheld otoacoustic emissions (OAE) screening is the most practical method for screening infants and toddlers because it :

  • objective and not dependent on a behavioral response from the child
  • Reliable and efficient
  • Help to detect sensorineural hearing loss and wide range of hearing-health concerns.
  • Is quick and painless
  • Simple and portable


What does ‘REFER’ or ‘FAIL’ mean?


Refer, an absent response to a click, does not always mean total deafness, but it does mean that your baby needs his/her hearing looking at more carefully.

The ear will not pass the screening if there is –

(a)  Blockage in the ear canal by wax or  amniotic,

(b) Structural problem or excess fluid in the middle ear

(c) Impaired cochlea that is not responding normally to sound.

What is the Hearing Screening Protocol ?

 All newborn should be screened at birth, or, within a month’s time.


Visual inspection – Outer ear abnormalities, foreign objects or blockage in the ear canal, any fluids draining from the ear, or noticeable odor; if any abnormal conditions are present, medical management should be done by ENT specialist.


Ist OAE screening – If both Ears Pass the test, the child’s hearing screening is considered complete

Those who have high-risk for hearing loss should be followed up at intervals of 6 months even if they are cleared at the screening. (As per Joint Committee on Infant Hearing 2000 position statement)

If the child does not pass the screening on any ear child is evaluated and managed by ENT specialist for a possible middle ear disorder within 3 months of age.

Repeat OAE screeningAfter treatment and/or medical clearance is obtained, the OAE screening is repeated.

If the ear passes the test, no further screening

However, if the ear dues not pass the Repeat test child is referred to a pediatric audiologist for complete Hearing evaluation like BERA (ABR), ASSR and Impedance.

Appropriate measures such as hearing aid fitting initiated before 6 months.


What are some of the warning signs of hearing loss in an infant?

If your child does not startle to loud noises or awaken from sleep by very loud noises in the house.

If your child is not babbling repetitively (ba ba, da da, etc.) by 8-10 months or

if your child doesn’t turn to localize the source of your voice by 7-8 months, you should be suspicious.

Ask for an objective set of tests. 

Red Flags Of Autism Spectrum Disorders


Image attributes flikr/helpingting (creative commons)

Different people with autism can have very different symptoms hence term “Autism Spectrum Disorder” (ASD).

Early signs of autism spectrum disorder are usually present before 18 months and parents usually know that there is something wrong with their kid. Family members and health care providers should value parent’s instinct and give importance to concern relating to child’s development.

Health care provider should know the fine line between typical and atypical development and should be able to recognize the Red Flags which indicates that a child should be evaluated and screened.

New born hearing screening and developmental screening should be done on slightest doubt.

Treatment should begin as early as possible by validated screening tools and should be tailored for every child to meet his needs.

Early intervention and educational approach may help in improving quality of life for autistic kid & family members.

Possible Red Flags for Autism

Social Interaction:

  • The child does not respond to his/her name.
  • The child doesn’t smile when smiled at.
  • The child has poor eye contact.
  • The child seems to be in his/her “own world.”
  • The child seems to tune people out.
  • The child is not interested in other children
  • The child seems to prefer to play alone
  • The child throws intense or violent tantrums.
  • The child is overly active, uncooperative, or resistant.
  • The child doesn’t know how to play with toys.
  • Child does not play ‘pretend’ games.
  • The child gets things for him/herself only.
  • The child is very independent for his/her age.
  • The child does things “early” compared to other children.
  • Have trouble understanding other’s feeling or talking about their own feeling


  • Not speak as well as other children his/her age?
  • The child cannot explain what he/she wants.
  • The child’s language skills are slow to develop or speech is delayed.
  • The child doesn’t follow simple directions.
  • At times, the child seems to be deaf
  • unusual voice quality

Repetitive Behaviors & Restricted Interests:

  • Repetitive movements with objects
  • Repetitive movements or posturing of body, arms, hands, or fingers
  • The child gets “stuck” doing the same things over and over and can’t move on to other things.
  • Repeat words or phrases said to them
  • Child spends a lot of time lining things up or putting things in a certain order. Have trouble adapting when routine changes.

Screening should also be done If the child…

  • Does not babble or gesture by 12 months of age
  • Does not say single words by 16 months of age
  • Does not say two-word phrases on his or her own (rather than just repeating what someone says to him or her) by 24 months of age
  • Has ANY loss of ANY language or social skill at any age.

Source- Center for Disease Control and Prevention (CDC)

On Autism Awareness Day aim should be to educate parents, health care providers, and child educators to identify and act early.

How hearing impairment is diagnosed in infant and young children?

Hearing loss can range from a mild impairment to profound loss. Conductive hearing loss is largely preventable and can be managed by medicine/surgery. Sensor neural hearing loss may need fitting with hearing aids.

Early identification of hearing loss in newborn and young children is of critical as he develops language and speech by hearing to his surroundings.

In general neonates and infants could be tested by BERA, children in the age group of 2 – 3 yrs could be screened using free – field audiometry, children above 4 yrs could be conditioned and then a audiometry can be performed to test hearing impairment.

Babies should be screened for hearing at birth especially high risk ones.

Child with mild hearing loss is generally labeled as inattentive or slow learner. Hearing should be tested as child grows at any time on slightest suspicion of hearing deficit by Parents, care givers, teachers and family doctors.

Screening for hearing has been done for many years but still does not detect hearing impairment as early as desirable. Mother’s instinct for her child is usually correct even at early age and should not be neglected.

The type of tests used to identify hearing loss depend on the age of the child, and include:

* Behavioural observation audiometry (BOA) – for babies less than seven months of age.

It consists of making noises, such as shaking a rattle close to ear, and then observing the baby’s response.

* Distraction method – it is formalized method of behavioral observation audiometry for children 7-19 months.

Infant sits on mother’s lap and one tester standing in front uses toys to raise attention. Other tester behind the child presents signals like shaking a rattle, or drum beat. First tester observes the child’s response. Response may be head turn, eye turn, frowning, sucking etc. After each response the signal intensity used to elicit a response is measured.

* Visual reinforcement orientation (VRA) – useful for children 7-30 months of age. The baby is taught to move their head towards sound by pairing it with an interesting visual stimulus, located in the direction of the speaker.  Their response to different sounds can then be measured. Test is done in sound proof room with speaker and headphone. The ears can be tested individually if the baby tolerates headphones.

* Performance audiometry test – older children are taught to respond to sounds by a performing a simple action or playing a game, such as dropping a marble when they hear the sound.

* Oto-acoustic emission – certain sounds generated by the inner ear can be recorded to check the function of the tiny hair cells in the cochlea.

* Auditory brainstem response testing – to check the electrical activity in the brain in response to a sound. Electrodes are placed on the head to measure the brain waves. It is most popular test for neonatal hearing assessment and for detection of hearing loss.

* Transtympanic Electrocochleography – to check the cochlea for signs of electrical activity in response to sound. It is better indicator of hearing threshold than any other auditory evoked response in children. An electrode is threaded through the eardrum to touch the cochlea and it requires general aneasthesia in children.

* Impedance audiometry or Tympanometry – a probe which snugly fits into the ear and air is pumped into the ear canal. Neonates and young infants may be examined so long as the probe tone is 660 Hz and not 220 Hz. Stapedius reflex are used to assess middle ear disfunction. Impedance audiometry is not an alternative to behavioral audiometry.t

** Hearing test for older children are same as for adult

Criteria for hearing screening of new born babies

First three years of life are critical for a child to develop speech and language skill. For effective language and communication skill development child need to hear normally. If any hearing impairment is there it should be managed at the earliest.

With modern technologies like Brain-stem evoked response audiometry it is possible to identify hearing-loss within days of birth.

There are certain criteria which needs to pay attention and newborn should be subjected to hearing evaluation:–

1. Parental concern about hearing levels or speech delay in their child

2. Family history of hearing loss

3. History of in-utero (cytomegalovirus, rubella or syphilis) or post natal infections (meningitis)

4. Low birth weight babies

5. Hyper Bilirubinemia

6. Cranio facial deformities or certain syndromes

7. Head injury

8. Recurrent or Persistent otitis media with effusion

9. Exposure to ototoxic drugs