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Early Hearing Detection and Intervention

Families Early Hearing Detection and Intervention

Newborn Hearing Screening

My baby failed a hearing screening. What does this mean?

Babies fail newborn hearing screenings for many reasons. For example, there could be debris or fluid your baby’s ear from the birthing process. If your baby does not pass the initial hearing screening, it is very important to go to the recommended follow up appointment. If your baby does have a hearing loss, you must take early steps if you want your baby to learn to listen and speak.

Who completed the hearing screening in the hospital, and why did they not give me a lot of information then?

Typically, a nurse or a technician will complete the newborn hearing screening at the hospital or birthing center. These professionals have been trained to conduct the screening and look for a pass or fail result. They may be screening the hearing of several babies each day and may have quite a lot of experience in actually doing hearing screenings. However, they usually have limited knowledge about hearing loss and what steps parents should take next and so they refer those questions to other professionals with more training, such as an audiologist. You can and should contact the coordinator of the Early Hearing Detection and Intervention (EHDI) program in your state or territory (if living in the United States) to find answers to your questions. You can find your state’s EHDI program here.
The professional who knows the most about hearing loss is a pediatric audiologist. If you feel your questions have not been answered by your state’s EHDI program, need more information, or want a second opinion, you should schedule an appointment with a pediatric audiologist. A list of pediatric audiologists located in the United States can be found here.
Families in the United States and from all around the world are also welcome to contact AG Bell’s Listen-Learn-Link Parent Support Line for free assistance in getting questions answered and accessing information about services where you live.

What if I suspect that my child has hearing loss?

Always trust your gut! Parents know their child better than anyone else. If you suspect your child has a hearing loss, you should seek a second opinion and continue to search for answers. For many reasons, a child can develop hearing loss later even when additional tests come back as “normal.” Tell your audiologist about your concerns and give real-life examples of why you think your child has a hearing loss. A list of pediatric audiologists located in the Unites States can be found here.

My baby passed the screening, why do I need to keep getting hearing tests done?

For many reasons, children can develop hearing loss as they grow. If you suspect that your child may have trouble hearing, see an audiologist immediately.

Here are some common medical reasons why a child may develop hearing loss:

Family history of early, progressive, or delayed onset permanent childhood hearing loss.
Neonatal intensive care of more than five days.
• Hyperbilirubinemia (high bilirubin level) with exchange transfusion regardless of length of stay
Aminoglycoside (drugs that may be harmful to hearing) administered for more than five days.
Asphyxia or hypoxic (not getting enough oxygen) Ischemic Encephalopathy.
Extracorporeal membrane oxygenation (ECMO) (putting oxygen into the baby’s blood).
In utero (in the womb) infections, such as herpes, rubella, syphilis, and toxoplasmosis.
Cytomegalovirus (CMV).
Mother + Zika and infant with no laboratory evidence and no clinical findings.
Mother + Zika and infant with laboratory evidence +/- clinical findings.
Craniofacial malformations, congenital microcephaly, congenital/acquired hydrocephalus, or temporal bone abnormalities.
Syndromes associated with hearing loss.
Culture-positive infections associated with sensorineural hearing loss, including confirmed bacterial/ viral meningitis, herpes viruses, varicella, or encephalitis.
Events associated with hearing loss (head trauma, chemotherapy).
Maternal substance abuse (alcohol/drug abuse).

HOW DOES AN AUDIOLOGIST TEST MY BABY'S HEARING?

The age of the child will determine what tests will be done.

Different tests may be completed depending on the age of the child.

Before any appointment, rub and lightly tug your child’s ears to get them used to the sensation. Most audiologic testing requires the child’s ears to be touched. Helping your child get used to allowing their ears to be touched can make the test go more smoothly and reduce the number of appointments needed to complete all testing. Even if your child does not let the audiologist touch the ear, most testing requires placing the tip of a probe into the child’s ear. The audiologist may ask you to place this tip into the child’s ear, to help continue the testing.

Auditory Brainstorm Response (ABR)

ABRs must be completed in a silent environment on a child who is mostly being still and quiet. It is ideal for your child to be asleep or quietly feeding.

Otoacoustic Emissions (OAEs)

This is a quick and easy test that only needs the child and the environment to be quiet. Feeding or a quiet phone/tablet may help distract your child and keep them quiet during the test.

Video Reinforcement Audiometry (VRA)

This test is for babies under the age of 2. The best way to start training your baby for this test is to have a noisy toy. Create sound to the left and right of the baby, watching for him/her to locate the sound. When your baby locates the sound, reward him/her with praise or by giving the toy to your baby.

Conditioned Play Audiometry (CPA)

Usually, this test is done when a child is between 2-5 years of age. The best way to prepare your child for this test is to play a “sound” game. The goal is to get your child to show you that they heard a specific sound by putting a toy in the bucket. For example, you make a sound. Tell your child that you heard that sound (say “I heard that” and point to your ears) and put a toy in a bucket. You may need to repeat yourself two or three times to show your child how this game works. Again, the goal is that when your child hears the sound, he or she gets to put a toy in a bucket. Examples of sounds you can use include “beep beep beep” and “buh buh buh.” When your child puts the toy in the bucket, give them a smile, and clap your hands or praise them.

WHAT TO DO NEXT?

If your child is identified with a hearing loss, we recommend you find a pediatric audiologist. They are uniquely trained to provide care for babies and children with hearing loss. If you cannot find a pediatric audiologist nearby, do not hesitate to look specifically for an audiologist who has experience working with kids. The following website includes a list of pediatric audiologists in the United States to help you get started.

Also locate and work with an early intervention specialist to determine the best next steps. This can include a speech and language evaluation to determine the milestones your child should be meeting. You can find your state’s early intervention program here.

Monitor changes in your child’s hearing

Your child’s hearing may change depending on the cause of the hearing loss. Your audiologist can tell you what kind of hearing loss your baby has and how much it may change over the course of your child’s life. You should monitor any changes and discuss what you see with your audiologist to determine if further testing is needed.

How can I find out the cause of my child’s hearing loss?

We do not always know whether a hearing loss is inherited or if a hearing loss has occurred for some other reason. We do know that there are a large number of genes (more than 90) that can cause a hearing loss to occur. The best way to determine the cause of hearing loss is to talk with an ear, nose, and throat specialist. Some causes of hearing loss are very obvious and easy to detect, such as a conductive hearing loss. Other causes of hearing losses may be hidden. Genetic testing may identify the source of hearing loss.

Will my child develop other disabilities?

Some causes of hearing loss are associated with a syndrome. About 30% of hearing losses that are genetic are syndromic, which means that there are other factors as well as hearing loss, such as vision loss. It’s important to identify if your baby has one of these syndromes as early as possible so families can better prepare for other disabilities that may show up or worsen later in your child’s life.

Frequently Asked Questions

How does hearing work?

How we Hear?
The outer ear:
- Sound is collected from the environment by the pinna and travels through the ear canal. The pressure from the sound then moves the ear drum.
The middle ear:
- Once sound vibrates the ear drum, it then travels through the three smallest bones in the body, called the ossicles, that make up the ossicular chain. The ossicular chain includes the malleus (“hammer”), incus (“anvil”), and stapes (“stirrup”). Movement of the ear drum or bones can be affected by fluid or pressure changes.
The inner ear:
- The inner ear is the organ of hearing and balance. The cochlea is a snail shape organ that houses fluid, hair cells, and membranes. The hair cells detect changes in the fluid, which sends the signal to the brain, and the brain recognizes this signal as sound.

How to read an audiogram?

An audiogram is a graph of hearing. It is created by plotting the softest sound a child can hear for different frequencies or pitches of sound. The top or bottom of the chart measures frequency or pitches ranging from very low pitches, like thunder, to very high pitches, like birds. The sides of the audiogram measure intensity or loudness with very soft sounds, like whispers, at the top of the chart and very loud sounds, like a lawn mower, at the bottom of the chart.

Normal hearing for kids is between –10 and 15 dB. Decibels (dB) is a reference unit of measurement for sound. The further down the chart your child’s hearing is graphed, the more significant the hearing loss is.

On the chart, you may see symbols to represent hearing. Red, O’s, or triangles represent the right ear, while blue, X’s, or squares represent the left ear. These symbols are air conduction thresholds, or when the sound travels through the entire outer, middle, and inner ear.

There may also be symbols such as < and [ for the right ear and > and ] for the left ear. These represent the results of a bone conduction test, if one was completed. Bone conduction refers to sound vibrates through the skull directly to the inner ear.

What is conductive hearing loss?

Conductive hearing loss occurs when the sound cannot reach the cochlea. In this case, the nerves and organ of hearing are working, but sound isn’t coming through the outer and/or middle ear. Some causes of conductive hearing loss can be fluid in the middle ear, a malformation in the outer ear, a malformation of the ear canal, or a break in the ossicular chain. Surgery may correct some or all of the hearing loss, depending on the cause.

What is sensorineural searing loss?

Sensorineural hearing loss occurs when there is hair cell damage or nerve damage. The signal (sound) cannot reach the brain to be processed. Some causes of sensorineural hearing loss include genetics, infections, malformation of the cochlea, high noise levels, ototoxic medication, hypoxia, and tumors. Sensorineural hearing loss is a permanent type of hearing loss. Research is currently being conducted for a cure; however, no significant findings are available yet.

What is auditory neuropathy?

Auditory neuropathy occurs when there is a dysynchrony in the firing neurons. The outer, middle, and inner ear may work perfectly normally, but the neurons past the inner ear and not sending a clear message to the brain. This is sometimes described as static on a radio: sometimes you can receive the message while other times it is just noise.

Important Things to Remember if Your Child has a Hearing Loss!

You are Not Alone

You do not have to go through the hearing evaluation and early intervention process alone. Most parents of newborns and children with hearing loss have typical (normal) hearing, and like you have learned to navigate the ins and outs of having a child with hearing loss. Families just like yours are here to help you go through this process. AG Bell has large network of parents and state chapters you can connect with as well as a free family membership. Connect with AG Bell to learn more about how we can support you and your family.

You and Your Child will be OK

After receiving the diagnosis of a hearing loss, it is ok to feel however you feel. It is not your fault that your child has a hearing loss. The only thing you can do is what is in front of you. Having a hearing loss will not stop your child from developing into a successful adult, but it is important to act right away by getting your child needed help! Listen to Lauren’s story of how hearing loss did not stop her from succeeding. Your child can blossom in spite of and even because of hearing loss. If your baby is diagnosed at birth, intervention should begin as soon as possible before he/she is 6 months old. If diagnosed later, intervention should start as soon as you receive the diagnosis.

Have questions or need to connect with someone who can help you make sure you are on track with getting your child the follow-up he needs? AG Bell’s Listen-Learn-Link Parent Support line is here: https://www.agbell.org/Families/Listen-Learn-Link-Parent-Support-Line.

Remember, early intervention is the key to success.

What other specialists may I need to see about my child’s hearing?

You may end up including several of the following specialists on your child’s care team:

Geneticist
Speech-language pathologist
Auditory-verbal therapist
Otolaryngologist
Oto-neurologist
Ophthalmologist
Special educator
Pediatrician

If the hearing loss is part of a syndrome, you may need additional doctors on your team that specialize in that syndrome or the other parts of the syndrome.

How will your Child Communicate, Grow, and Thrive?

At AG Bell, one of our primary goals is to help families find information and resources related to listening and spoken language services, and professionals that help a child hear and talk, including audiologists and listening and spoken language professionals. AG Bell can help point you in the direction of local services and resources. AG Bell recognizes that parents/caregivers need or may want comprehensive information regarding all of the communication options (e.g., Cued Speech/Language, American Sign Language) and opportunities available to their child. If we do not have answers to your questions, we will point you to other organizations that may be able to help you.

It is important that your child and family connect with services and providers who can help you reach the outcomes you have identified (e.g., I want my child to make the most of his hearing and learn to talk). Whether you contact the AG Bell Parent Consultant, your local AG Bell chapter, or another organization, the most important thing is that your child and family get the support you need so your child can live a life without limits!

RESOURCES AND HELPFUL LINKS

Need to Talk with a Parent Consultant?

Where else can I get more information about newborn hearing screening?

Contact your state coordinators! Every state has a coordinator for information on hearing loss for individual states. There may be resources that are available that you can take advantage of.