Introduction: Course objectives

Audiology Practice

How the Ear Works

Hearing Loss

Detecting and Diagnosing Hearing Loss in Children

Newborn Hearing Screening

Hearing Testing

Medical Evaluation

Intervention for Children with Permanent HL

Case studies


Credits and Acknowledgements


Last updated: 15-sep-10

Newborn hearing screening

Early Hearing Loss Diagnosis and Intervention

Why is early diagnosis of hearing loss and early intervention important?
Left undetected, hearing impairments in infants can negatively impact speech and language acquisition, academic achievement, and social and emotional development. If detected, however, these negative impacts can be diminished and even eliminated through early diagnosis and intervention. Because of this, the National Institutes of Health's (NIH) Consensus Development Conference on Early Identification of Hearing Loss (1993) concluded that all infants should be screened for hearing impairment, preferably prior to hospital discharge. At the time of the NIH Consensus Development Conference, there were only 11 hospitals screening more than 90 percent of their babies. Since then, there has been a rapid increase in the number of universal newborn hearing screening (UNHS) programs which have been implemented in the United States. Currently approximately 90% of babies born in the state of Washington receive newborn hearing screenings.

Research has compared children with hearing loss who receive early intervention and amplification before 6 months of age versus after 6 months of age. By the time they enter first grade, children identified earlier are 1 to 2 years ahead of their later-identified peers in language, cognitive, and social skills.

What are the 1-3-6 goals of EHDI?
Early Hearing Detection and Intervention (EHDI) refers to the process of screening every newborn for hearing loss prior to hospital discharge, whereby infants not passing the screening receive appropriate diagnostic evaluation before three months of age and, when necessary, are enrolled in early intervention programs by six months of age. In identifying infants with hearing loss and enrolling them in early intervention programs, an early hearing detection and intervention (EHDI) program should encompass these three basic components: newborn hearing screening, audiological diagnosis, and early intervention. Threaded throughout these components should also be some key elements—culturally-competent family support, medical home, data management, legislative mandates, and program evaluation tools.

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Universal Newborn Hearing Screening

Hearing screening programs are called "universal" because the goal is to test all newborn babies. This means that babies in both the regular and intensive care nurseries are screened before they leave the hospital.

Newborn Hearing Screening Tools

Behavioral test methods are not reliable measures for detecting hearing loss in newborn infants. Phyisologic tests, the otoacoustic emission (OAE) test, and brainstem auditory evoked response (BAER) test are the recommended methods for newborn hearing screening. These methods are discussed in the section “Hearing Testing

What does it mean when a baby does not pass a newborn hearing screening test?
When a baby does not pass the newborn hearing screening test, this does not necessarily mean the baby has a hearing loss. Across the nation, between 20 to100 babies per 1000 (2 to 10 percent) do not pass the screening test. Only one to three babies per 1000 (less than 1 percent) actually have hearing loss. This means that many of the babies referred for follow-up testing will be shown to have normal hearing. However, all babies with congenital hearing loss will be in the group of babies who do not pass the newborn hearing screening. A baby with normal hearing could fail the newborn hearing screening test due to vernix in the ear canal, fluid in the middle ear, or movement and/or crying during the test. If a baby does not pass the newborn hearing screening test, it is very important to make sure the baby gets follow-up testing to determine the baby’s hearing status.

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For more information about EHDI:

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Center on Human Development and Disability, UW LEND, University of Washington,
Box 357920, Seattle, WA 98195-7920