Newborn Hearing Screening

Updated: Jun 28, 2018

Author

Anne M Delaney, PhD Senior Audiologist, Coordinator of Newborn Hearing Program,

Department of Otolaryngology-Head and Neck Surgery, University of Virginia Medical Center

Overview

Universal screening programs have been implemented across the United States. Hearing loss
occurs often enough in the general population to justify the legislation for universal hearing
screening programs across the United States.

Hearing loss is one of the most common congenital anomalies, occurring in approximately 2-
4 infants per 1000. Prior to implementation of universal newborn screening, testing was
conducted only on infants who met the criteria of the high-risk register (HRR). It was found
that the HRR was not enough, given that as many as 50% of infants born with hearing loss
have no known risk factors. Reliable screening tests that minimize referral rates and maximize
sensitivity and specificity are now readily available.

Early identification and intervention can prevent severe psychosocial, educational, and
linguistic repercussions. Infants who are not identified before 6 months of age have delays in
speech and language development. Intervention at or before 6 months of age allows a child
with impaired hearing to develop normal speech and language, alongside his or her hearing
peers.

A study from the Centers for Disease Control and Prevention (CDC) found that in the United
States between 2006 and 2012, in newborns screened for hearing loss, the rate of hearing
impairment diagnoses for those who did not pass their final screening test rose from 4.8% to
10.3%, while the rate of enrollment in early intervention services among children diagnosed
with hearing loss grew from 55.4% to 61.7%. According to the study, however, reporting is
inconsistent with regard to diagnostic test results (as opposed to screening results) and
enrollment in early intervention. [1]

See Table 1 below for common misconceptions held by the public about hearing loss and its
identification in infants. Universal newborn hearing screening is essential to the normal speech
and language development in the large number of infants born with hearing loss in the United
States each year.

able 1. Common Misconceptions Held by the Public and the Clinical Facts (Open Table in a
new window)

Misconception Clinical Fact

Parents will know if their child Prior to the universal screening, the average age at which
has a hearing loss by the time children were found to have a hearing loss is 2-3 years.
their child is 2-3 months of age. Children with mild-to-moderate hearing loss were often
not identified until 4 years of age.
 Parents can identify a hearing Children can compensate for a hearing loss. They use
loss by clapping their hands visual cues, such as shadows or parental expressions and
behind the child's head. reactions, or they may feel the breeze caused by the
motion of the hands.
The HRR is all that is needed to The HRR misses approximately 50% of all children with
identify children with hearing hearing loss.
loss.
Hearing loss does not occur often Hearing loss affects approximately 2-4 per 1000 live
enough to justify the use of births, and it has been estimated to be one of the most
universal screening programs. common congenital anomalies.
Tests are not reliable and cause Referral rates are as low as 5-7%.
too many infants to be referred to
specialists.
There is no rush to identify a Children identified when they are older than 6 months
hearing loss. The loss does not can have speech and language delays. Children identified
need to be identified until a child when they are younger than 6 months do not have these
is aged 2-3 years. delays and are equal to their hearing peers in terms of
speech and language.
Children younger than 12 months Children as young as 1 month of age can be fit with and
cannot be fitted with hearing benefit from hearing aids.
aids.

Prevalence of Hearing Loss

The ability to hear during the early years of life is critical for the development of speech,
language, and cognition.

Retrospective studies of large universal newborn hearing screening programs have shown that
permanent hearing loss is one of the most common abnormalities present at birth. In 1999, the
American Academy of Pediatrics Task Force on Newborn and Infant Hearing stated,
"significant bilateral hearing loss has been shown to be present in approximately 1 to 3 per
1000 newborns in the well-baby nursery population, and in approximately 2 to 4 per 1000
infants in the intensive care unit population." [2] Data from the newborn hearing-screening
programs in Rhode Island, Colorado, and Texas show that 2-4 of every 1000 neonates have
hearing loss (see Table 2 below). [3, 4, 5] A retrospective study conducted by Connolly et al in
2005 found that 1 of every 811 infants without risk factors and 1 of every 75 infants with risk
factors have hearing loss. [6] The prevalence of hearing loss may continue to change as more
data becomes available from universal newborn hearing screening programs.

1. Williams TR, Alam S, Gaffney M, Centers for Disease Control and Prevention (CDC).
Progress in identifying infants with hearing loss—United States, 2006-2012. MMWR
Morb Mortal Wkly Rep. 2015 Apr 10. 64 (13):351-6. [Medline]. [Full Text].
2. Erenberg A, Lemons J, Sia C, Trunkel D, Ziring P. Newborn and infant hearing loss:
detection and intervention.American Academy of Pediatrics. Task Force on Newborn and
Infant Hearing, 1998- 1999. Pediatrics. 1999 Feb. 103(2):527-30. [Medline].
3. Vohr BR, Carty LM, Moore PE, Letourneau K. The Rhode Island Hearing Assessment
Program: experience with statewide hearing screening (1993-1996). J Pediatr. 1998 Sep.
133(3):353-7. [Medline].
4. Downs MP. Universal newborn hearing screening--the Colorado story. Int J Pediatr
Otorhinolaryngol. 1995 Jul. 32(3):257-9. [Medline].
5. Finitzo T, Albright K, O'Neal J. The newborn with hearing loss: detection in the nursery.
Pediatrics. 1998 Dec. 102(6):1452-60. [Medline].
6. Connolly JL, Carron JD, Roark SD. Universal newborn hearing screening: are we
achieving the Joint Committee on Infant Hearing (JCIH) objectives?. Laryngoscope. 2005
Feb. 115(2):232-6. [Medline].

Access on https://emedicine.medscape.com/article/836646-overview#a1 tanggal 09 Januari 2019