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Hearing Loss in
Newborns & Infants
Presented by: ACC ~ The Audiology Awareness Campaign
Hearing loss in newborns and infants:
The earlier it can be detected,
the better it can be managed.
Why should we screen for hearing loss?
The lack of hearing can keep a child from learning language and speaking normally. Language and speech are among the most important skills we need to impart to our children so that they can become literate, self-sufficient citizens when they mature.
Who should be screened for hearing loss?
There are people who feel all newborns should be screened, and others who feel that we should start with children at high risk (for example: prematures, jaundiced babies, infants with family history of deafness, etc.). But, everyone agrees that the earlier the diagnosis is made, the better for the child. Dr. Christy Yoshinaga-Itano has shown that when hearing impaired children who receive treatment before six months old, language develops far earlier than for children who are not managed until after one year. In fact, some children managed early show normal language development comparable to normally hearing peers.
How is hearing screening in newborns done?
There are two commonly used screening tests:
(a) An automated ABR which does a computer controlled screening ABR test and tells the operator whether or not to refer for full diagnostic work up. This evaluates the effectiveness of the inner ear and nerves in sending messages to the brain.
(b) An automated otoacoustic emissions screening test which also alerts the diagnostician to whether or not additional testing is appropriate. This test measures sounds which come from hair cells in the inner ear; these sounds are only present when the hair cells are normal.
What should happen if a child fails a screening test?
A full diagnostic battery of otoacoustic emissions and auditory brainstem testing should be performed by an audiologist. Additional techniques may be indicated to identify the nature and degree of loss.
What are the possible outcomes?
Normal. Both otoacoustic emissions and ABR are normal at very low levels of sound for all different types of stimuli. Such children will not have speech and language problems that can be helped with hearing aids.
Absent responses. No ABR and no emissions usually mean severe to profound hearing loss. These children can usually be helped with hearing aids and/or cochlear implants and special education by experts in hearing loss. An absent response to a click, however, does not always mean total deafness.
Normal Emissions and absent or "mirror-image" ABR. This is consistent with a so-called auditory neuropathy where the waves obtained through the two different polarity clicks are mirror images and really come from a part of the inner ear that does not respond to hearing aids. Thes patients require special attention from experienced diagnosticians, do not usually learn language through their hearing mechanism at first, but may respond well to cued speech language (a method of teaching your native language with the aid of hand and mouth positions which is usually easy for normal hearing parents to learn and use). Some children with jaundice in their backgrounds actually outgrow the hearing problem. Others get worse and may respond to cochlear implants. This is a new area and many professionals disagree on management or are unfamiliar with the issues. It is important that you consult with one or more audiologists who are experienced in this area.
Can an audiologist tell a child is hearing impaired by just observing how they respond to sound?
Not always. Although, if you feel your child has a hearing problem, trust your judgment and ask for some objective tests to validate or allay your concerns. Most audiologists today rely on objective tests in addition to their own clinical observations. While any objective test can be misinterpreted or poorly administered, they usually help confirm/refute the behavioral observations which, in turn, can be done under highly controlled statistical and computer controlled conditions.
What are some of the warning signs of hearing loss in an infant?
If your child does not startle to loud noises or awaken from sleep by very loud noises in the house. If your child is not babbling repetitively (ba ba, da da, etc.) by 8-10 months or if your child doesn't turn to localize the source of your voice by 7-8 months, you should be suspicious. Ask for an objective set of tests by an audiologist.
This article was originally submitted by Charles I. Berlin, Ph.D., Director, Kresge Hearing Research Laboratory of the South, LSU Medical Center, Department of Otolaryngology, and subsequently edited by AAC.
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