by Rosenblum LB

Screening for Hearing Loss

Screening tests for hearing provide a quick way to find people who have hearing loss. Early detection of hearing loss allows treatment to be provided sooner and helps prevent further problems.
When people do not pass a hearing screening test they are given an in-depth hearing evaluation by an audiologist and further care if necessary. Hearing screening is provided from birth throughout adult years when it is requested, under conditions that increase risk for hearing loss, or when required by state or local laws.
Hearing screening is especially important for newborns, infants, and young children because hearing is critical to a child’s development. A child’s speech, language, and social and academic skills can be affected by even mild or partial hearing loss. Therefore, it is optimal for early hearing loss to be diagnosed and treated within a baby’s first six months.
The American Academy of Pediatrics and several other organizations recommend that all newborns be given a hearing screening test, and 30 states require hearing screening for all newborns. Newborn screening programs have three primary goals:
  • Newborns should be screened before leaving the hospital or within their first month.
  • If a newborn does not pass the test, follow-up hearing and medical evaluations should be given by three months of age.
  • Babies who have hearing loss should get services before six months of age to help them develop speech, language, and social skills.
The American Academy of Pediatrics has also issued guidelines that contain a schedule of the times infants and children should be screened through adolescence. The main age ranges and screening tests are given below.

Birth to 9 Months

After the initial screening for all newborns within the first month, infants with risk factors should be tested every six months until age 3.
Otoacoustic Emissions —These emissions are faint sounds produced by the cochlea when sound stimulates it. Although people cannot hear these sounds, they can be picked up and measured by a small probe placed in the ear canal. These emissions are produced by people with normal hearing but not by those with a certain level of hearing loss. This test can detect blockage or damage in different parts of the ear and is often used with babies.
Auditory Brainstem Response —Electrodes are attached to the scalp to measure electrical response in the brain to sounds. This test helps determine the possible location of certain hearing problems. It is frequently used with babies.

9 Months to 2.5 Years

Children in this age range should be tested as needed. Those who are at risk for hearing loss should be tested at least every six months until age 3. Behavioral tests are used, such as visual reinforcement audiometry and conditioned play audiometry, that measure responses of the child to speech and other sounds presented through speakers.

2.5 Years to 4 Years

Children in this age range should be tested as needed. Conditioned play audiometry is the most commonly used hearing test for this age range. The sounds are presented through earphones or a bone vibrator rather than speakers.
Also recommended is acoustic immittance screening for disorders of the outer and middle ear since hearing loss at this age is often caused by middle ear disease such as ear infections. This type of screening can include tympanometry, acoustic reflex, and static acoustic measures.

4 Years to 18 Years

Children in this range should be screened when they first enter school, every year from kindergarten through 3rd grade, and in the 7th and 11th grades. Conventional audiometric tests are used for this age group. Students are asked to raise their hand when they hear a tone through earphones or from a bone vibrator. Conditioned play audiometry may also be used with this age group.

Adults

Screening in adult years is considered voluntary. However, it is recommended that adults get screened at least every 10 years from ages 18 through 50. Screening should be performed every three years after age 50 since hearing loss becomes increasingly common in later years. Conventional audiometric tests are used for this age group.

References

Bush JS. AAP issues screening recommendations to identify hearing loss in children. Am Fam Physician. 2003;67:2409-2413.

Hearing screening. American Speech-Language-Hearing Association website. Available at: http://www.asha.org/public/hearing/testing/default.htm?print=1 . Accessed September 18, 2013.

Isaacson JE, Vora NM. Differential diagnosis and treatment of hearing loss. Am Fam Physician. 2003;68:1125-1132.

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