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Hearing Screening: Newborn and Infancy

Provider Tools

  • Newborn Hearing Screening Checklist
    Track hearing screening results, pediatric audiologic evaluation and services, early intervention services, and medical evaluation results in one place in the patient’s chart. (From the American Academy of Pediatrics)
  • Hearing Flowchart and Template
    Step-by-step guide on hearing screening, diagnosis and management

(From the American Academy of Pediatrics)

Information for Parents

    • National Center for Hearing Assessment and Management (NCHAM)
      NCHAM works to ensure that all infants and toddlers with hearing loss are identified as early as possible and provided with timely and appropriate audiological, educational, and medical intervention.
  • From Boys Town Center for Childhood Deafness)

What can you do in your office practice?

    • Check each infant’s hospital record for results of a newborn hearing screening.  If no screening has been done or if an infant was born at a birthing center, at home or another site that does not do screening, refer the child to a pediatric audiologist for newborn hearing screening before 1 month of age.
    • If the infant did not pass the newborn hearing screening, refer the infant to a pediatric audiologist.  This is the most important step for Primary Care Providers. Many screening programs do not offer follow-up testing, but do inform the parents of the screening outcome and provide a list of audiologists as needed.
    • Assure the family obtains follow-up testing on their infant.What kind of hearing testing is appropriate for infants and young children?
      • Hearing Testing in Infants
        For infants under 6 months of age, either otoacoustic emissions (OAEs) or brainstem auditory evoked responses (BAER, ABR) are appropriate screening tools. Both OAE and frequency-specific BAER testing are necessary to diagnose hearing loss.
      • If a hearing loss is identified
        Once a child is diagnosed with a hearing loss, the audiologist will provide recommendations on amplification and early intervention. The primary health care provider should monitor the process to ensure that both amplification and early intervention are initiated.

Additional Information

Hearing Screening: Preschool

Information for Health Care Providers

What can you do in your office practice?

    http://medicalhome.org/monitoring/hearing/hearing-screening-newborn-and-infancy/

      • Screen for hearing risk factors by history and physical exam.  Inquire about parental concerns.
      • Monitor speech, language and hearing milestones.
      • Screen hearing routinely at 4 and 5 years of age and screen all children not previously screened (recommended by AAP – Recommendations for Preventive Pediatric Health Care, and Bright Futures Guidelines for Health Supervision). In addition, screen with tympanometry and pure tone audiometer in the office when indicated because of concerns on history or physical examination.
      • Perform tympanometry, if indicated.
      • Refer any child with concerns, risk factors or delayed milestones for hearing assessment.
        • If a hearing loss is identifiedOnce a child is diagnosed with a hearing loss, the audiologist will provide recommendations on amplification and interventions, such as speech and language therapy. The primary health care provider should monitor the process to ensure that both amplification and intervention services are initiated.

Office Hearing Screening in Young Children

From 7 months to 4 years of age (developmentally)
At this age, hearing screening is subjectively based on behavioral cues, developmental milestones, risk factors and parental concern.  If there is a concern:

      • Children younger than 2 years will need to be referred for audiologic assessment using VRA (see below).
      • A child developmentally between 2 and 4 years of age can be screened with conditioned Play Audiometry:
        Screening is done under earphones.  The child is conditioned to perform a task (a ‘listening game’), such as placing a peg in a pegboard, each time a sound stimulus is heard.  Sounds are presented at 1000, 2000, and 4000 Hz at 20dB level. Ear-specific results are obtained.  Administer a couple of trials at a ‘superthreshold’ level of sound to ensure the child understands the task.  Then present at least two stimuli at each sound level to check for child response.

Pass/refer criteria

      • Pass if reliable response present at each dB level at each frequency in each ear.
      • Retest – if does not pass, readjust earphones, reinstruct in the task and rescreen in the same screening session
      • Refer – if fails rescreen or cannot learn screening task

4 and 5 year old children should be screened with pure tone audiometry
Conduct screening under earphones using 1000, 2000, and 4000 Hz tones at 20dB.  The child is instructed to raise a hand or press a button each time a sound stimulus is heard.  Ear-specific results are obtained.  The child is instructed to raise a hand or press a button each time a sound stimulus is heard.  Ear-specific results are obtained.

Pass/refer criteria

      • Pass if reliable response present at each dB level at each frequency in each ear.
      • Retest – if does not pass, readjust earphones, reinstruct in the task and rescreen in the same screening session
      • Refer – if fails rescreen or cannot learn screening task

Hearing Testing in Young Children (Audiologist)

See ‘Hearing Tests‘ section for further information.

      • Visual Reinforcement Audiometry
      • Play Audiometry
      • Conventional Audiometry

Hearing Screening: School Age and Older

Information for Health Care Providers

What can you do in your office practice?

      • Screen for hearing risk factors by history and physical exam.  Inquire about parental concerns.
      • Monitor school performance and results of hearing screening in school settings.
      • Screen hearing routinely at 4, 5, 6, 8,10, 12, 15, and 18 years of age (recommended by AAP – Recommendations for Preventive Pediatric Health Care, and Bright Futures Guidelines for Health Supervision). In addition, screen with tympanometry and pure tone audiometer in the office when indicated because of concerns on history or physical examination.
      • Refer any child with concerns, risk factors or delayed milestones for hearing assessment.
        • Washington state pediatric audiology resources
        • Assure the family obtains follow-up testing on their child.
        • If a hearing loss is identified ensure that both amplification and intervention services are initiated.
          Once a child is diagnosed with a hearing loss, the audiologist will provide recommendations on amplification and other interventions, such as speech and language therapy.

Office Hearing Screening in School Age Children

Conventional Audiometry Screening – Useful in children at a developmental age of 4 years and older

Conduct screening under earphones using 1000, 2000, and 4000 Hz tones at 20dB.  The child is instructed to raise a hand or press a button each time a sound stimulus is heard.  Ear-specific results are obtained.  The child is instructed to raise a hand or press a button each time a sound stimulus is heard.  Ear-specific results are obtained.

Pass/refer criteria

      • Pass if reliable response present at each dB level at each frequency in each ear.
      • Retest – if does not pass, readjust earphones, reinstruct in the task and rescreen in the same screening session
      • Refer – if fails rescreen or cannot learn screening task

Hearing Testing in School Age Children (Audiologist)

See ‘Hearing Tests‘ section for further information.

      • Play Audiometry
      • Conventional Audiometry

References and Further Resources

  • AAP Clinical Report. (2009) Hearing Assessment in Infants and Children:Recommendations Beyond Neonatl Screening.  Harlor AD, Bower C.  Committee on Practice and Ambulatory Medicine.  Section on Otolaryngology: Head and Neck Surgery.  Pediatrics. 124:1252-1263.
  • Bright Futures – Recommendations for Preventive Health Care (2008).