Newborn Infant Hearing Screening (cont.)

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What is the difference between a hearing screen and a diagnostic hearing test?

The basic difference between a diagnostic test and a hearing screen is the amount of information gathered during the session. For example, if an infant fails the hearing screen, it is unknown if there truly is a hearing loss, how much hearing loss is present, or whether or not the hearing loss is permanent or correctable. A diagnostic test can usually answer these questions. The diagnostic test session is understandably longer and requires more interaction with the infant. Typically, a more extensive ABR is conducted, using a variety of test stimuli. OAEs are also performed to cross-check the results of the ABR. To complete a thorough test, the infant needs to sleep in the office for upward of 45 minutes. The more information that can be collected, the more complete the results will be.

If an infant does not pass a hearing screen in the hospital, what happens next?

Most hospital screening programs will refer infants who failed the initial screening test to a secondary center that specializes in more complete testing for diagnosis. Sometimes, simple problems, such as too much residual amniotic fluid and vernix in the ear canal, will resolve prior to the rescreen and the infant will pass the second test. The rescreen is an important step in determining whether the infant is able to hear, so it should not be taken lightly.

If an infant does not pass the rescreen, then a full diagnostic test will be necessary. This test may be completed at the rescreen site or at another facility, depending on several factors.

If an infant has a hearing loss, what is the next step?

The ability of an infant to compensate for the hearing loss will depend on both the type and the degree of hearing loss.

The type of hearing loss refers to where in the ear the hearing loss is located and what is causing it. There are two basic types of hearing loss, conductive and sensorineural. A conductive loss is caused by problems in the outer or middle ear. This is the type of loss that results when a child has a middle-ear infection, trapped fluid from birth, impacted wax in the outer ear or malformation of the ear and associated structures. It is usually correctable with medical treatment or surgery. Occasionally, a conductive loss cannot be corrected with surgery. However, these children typically do extremely well with hearing aids. A sensorineural loss is indicative of a problem in the inner ear or somewhere along the nerve to the ear (auditory nerve). This type of loss is typically permanent and cannot be corrected with surgery. A hearing aid or a cochlear implant may be utilized in this situation.

The degree of hearing loss refers to the severity of the hearing loss, which can range from mild to profound. Although the term "mild" sounds relatively benign, a mild hearing loss in a child who is trying to develop speech and language can have a huge impact on his/her success.

If the hearing loss, whether it is conductive, sensorineural, or a combination of both, is determined to be uncorrectable by a physician, then the next step is to fit the infant with hearing aids. This is accomplished by a pediatric audiologist who can adjust the hearing aids according to the baby's hearing loss and monitor the infant's progress through regular visits. The infant should also be enrolled in an early childhood intervention program that is often provided through the school system.

In addition to the early medical or surgical treatment of the hearing loss, parental involvement is essential. Parents need to monitor the child's progress and facilitate and encourage the use of the hearing aids and other therapeutic exercises that are designed to help the child become a careful listener and talker. Research has found that the one common denominator among successful hearing-impaired children is the parent's willingness to help the child throughout his/her lifetime.

Summary & Recommendations (from the American Academy of Pediatrics Preventative Series Task Force -- July 2008)

Importance: Children with hearing loss have increased difficulties with verbal and nonverbal communication skills, increased behavioral problems, decreased psychosocial well-being, and lower educational attainment compared with children with normal hearing.

Detection: Because half of the children with hearing loss have no identifiable risk factors, universal screening (instead of targeted screening) has been proposed to detect children with permanent congenital hearing loss. There is good evidence that newborn hearing screening testing is highly accurate and leads to earlier identification and treatment of infants with hearing loss.

Benefits of detection and early treatment: Good quality evidence shows that early detection improves lingual outcomes.

Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCE:

"Screening the newborn for hearing loss"
uptodate.com


Medically Reviewed by a Doctor on 2/18/2014

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