Universal Newborn Hearing Screening
Frequently Ask Questions for Healthcare Providers
Please
choose from the questions below for more information about Universal
Newborn Hearing Screening / Early Hearing Detection & Intervention:
What
is the purpose of Universal Newborn Hearing Screening (UNHS)?
The purpose of newborn hearing screening is to identify children
who are at greater risk for hearing loss so that they may receive
timely diagnostic and intervention services. Hearing screenings
are NOT diagnostic evaluations. Screening tests identify a need
for further diagnostic hearing evaluations.
What
is the incidence of hearing loss in newborns?
Approximately 3 in 1,000 babies are born with a hearing loss.
1 in 1,000 babies are born deaf. 90% of children with hearing
loss are born to hearing parents. The earlier that the hearing
loss is identified, the sooner that intervention may begin.
What
is the youngest age that a child’s hearing can effectively
be tested?
Hearing can be assessed at any age, even the day that a child
is born. Brainstem Auditory Evoked Response (BAER) and Evoked
Otoacoustic Emissions (EOAE) evaluations are an effective and
efficient means for identifying and quantifying hearing loss.
What
are the differences between BAER and EOAE evaluations?
The BAER evaluation is conducted by placing electrodes on the
child’s forehead and mastoid areas. Earphones are used
to deliver sound to the child’s ear, either in the form
of a click or pure tone stimulus. The BAER measures the neural
response from the cochlear to the brainstem. It is a measure
of neural synchrony along the auditory pathway.
The
EOAE evaluation is performed by placing a small earphone into
the child’s ear. Clicking sounds are introduced into the
child’s ear. “Echo” responses, or emissions,
are measured in healthy ears. EOAEs are acoustic signals generated
by the cochlea, specifically, outer hair cells, in response
to auditory stimulation. In response to click stimuli, EOAEs
provide information over a broad frequency range (~500-6000Hz).
Present EOAEs indicate that a child has no greater than a mild
hearing loss.
Both
tests are effective for newborn hearing screening.
What
are the referral rates for these tests?
Referral rates have decreased significantly in the last few
years. With recent advances in equipment, it is not unusual
to have referral rates of 2%-3% for automated BAER and EOAE
screenings.
What
happens if a baby needs to be re-screened?
It is important for parents to understand that referral for
a second screening does not necessarily mean their baby has
a hearing loss. Information about hearing screening must be
provided to parents in a professional, thoughtful, and sensitive
manner. Parental stress should be minimized while conveying
the importance of appropriate follow-up.
The
most common reasons that a child would need a re-screen include
otitis media with effusion, an ear canal blocked with debris,
or a permanent hearing loss.
What
is a pediatric diagnostic hearing evaluation?
The BAER or EOAE may be repeated. If necessary, a diagnostic
BAER may also be performed in order to determine the child’s
hearing thresholds. Pure tone stimuli are used in order to determine
hearing thresholds at specific frequencies.
What
if a hearing loss is identified?
The goal of universal newborn hearing screening is to identify
children with hearing loss early, in order to initiate intervention
services by six months of age. Intervention services include
properly fitted amplification, family focused communication
strategies, early childhood services, and parental support groups.
Why
not wait until babies are older?
The critical years for the acquisition of speech and language
are 0-3, making early identification crucial. Children with
hearing loss, even those with mild to moderate losses, who are
identified later in life, may have social-emotional difficulties
as well as language and educational delays. Parent-child relationships
are compromised when there is an unrecognized difference in
hearing status between parent and child. The earlier that a
hearing loss is identified and intervention begins, the more
natural parent-child communication may become. This enhances
parent-child bonding and the child’s social-emotional,
cognitive, and language development.
Why
screen all newborns? Why not just those identified as high risk
by the Joint Committee on Infant Hearing?
The Joint Committee’s high-risk criterion include but
are not limited to:
- Any
illness or condition requiring admission to a NICU for greater
than or equal to 48 hours,
- A
syndrome associated with congenital or progressive hearing
loss,
- A family history of permanent childhood hearing
loss,
- Craniofacial anomalies,
- Bacterial meningitis,
- Severe hyperbilirubinemia,
- Head trauma,
- Recurrent otitis media, and
- Parental concern
However,
over 50% of children with congenital hearing loss don’t
meet any of these risk criteria, and would not be identified
if the high-risk register was used as the only criterion for
screening newborns.
If
a child passes the newborn screen, when should they be tested
again?
Children with any risk factors for progressive hearing loss
should continue to have their hearing monitored. If speech-languages
milestones are delayed, the child’s hearing should be
re-evaluated. Also, if the child’s parent is concerned,
re-evaluation is usually appropriate.
How
is hearing tested in older babies?
As children grow, the testing techniques also change. BAER and
EOAEs are commonly used until a child is old enough to provide
behavioral responses to sound, usually around 7-8 months of
age. At this time, behavioral tests such as Visual Reinforcement
Audiometry (VRA) are employed.
What
can you do?
As the child’s primary healthcare provider, parents rely
on and respect your judgment. Your encouragement and recommendations
to families regarding follow-up for newborns that need to be
re-screened is vital.
In
addition, you are the professional best able to monitor the
child’s speech and language development, and are entrusted
to refer for a hearing loss evaluation when you or the parents
have concerns.
If
you have any questions or would like more information regarding
newborn hearing screening, please for additional resources.