Hearing Screening In Children

Congenital or acquired hearing loss in infants and children has been linked with lifelong deficits in speech and language acquisition, poor academic performance, personal-social maladjustment and emotional difficulties. Identification of hearing loss through neonatal hearing screening, regular surveillance of developmental milestones, auditory skills, parental concerns and middle-ear status and objective hearing screening of all infants and children at critical developmental stages can prevent or reduce many of these adverse consequences.

Being diagnosed before the age of 9 months was associated with better receptive and expressive language skill at about 8 years, and was also associated with a better match between verbal and non-verbal ability. The simple act of screening was associated with better receptive language skills.


Parents should notify their health care providers if they notice that their child does not perform appropriate to their age as mentioned below:


  • 0-4 months of age: Should startle to loud sounds, quiet to mother's voice, momentarily cease activity when sound is presented at a conversational level.
  • 5-6 months: Should correctly localize to sound presented in a horizontal plane, begin to imitate sounds in own speech repertoire or at least reciprocally vocalize with an adult.
  • 7-12 months: Should correctly localize to sound presented in any plane, should respond to name, even when spoken quietly.
  • 13-15 months: Should point toward an unexpected sound or to familiar objects or persons when asked.
  • 16-18 months: Should follow simple directions without gesture or other visual cues; can be trained to reach toward an interesting toy at midline when a sound is presented.
  • 19-24 months: Should point to body parts when asked; by 21 months the child can be trained to perform play audiometry.


Ten Ways to Recognize Hearing Loss: Adolescents (11- to 21-Year Visits)


  • Do you have a problem hearing over the telephone?
  • Do you have trouble following the conversation when two or more people are talking at the same time?
  • Do people complain that you turn the TV volume up too high?
  • Do you have to strain to understand conversation?
  • Do you have trouble hearing in a noisy background?
  • Do you find yourself asking people to repeat themselves?
  • Do many people you talk to seem to mumble (or not speak clearly)?
  • Do you misunderstand what others are saying and respond inappropriately?
  • Do you have trouble understanding the speech of women and children?
  • Do people get annoyed because you misunderstand what they say?


Risk Indicators Associated With Permanent Congenital, Delayed-Onset and/or Progressive Hearing Loss in Childhood:


All infants with a risk indicator for hearing loss, regardless of surveillance findings, should be referred for an audiologic assessment at least once by 24 to 30 months of age, even if the child passed the newborn hearing screening. Children with risk indicators that are highly associated with delayed-onset hearing loss should have more frequent audiological assessments.


  • Caregiver concern regarding hearing, speech, language, or developmental delay.
  • Family history of permanent childhood hearing loss.
  • Neonatal intensive care of more than 5 days or any of the following regardless of length of stay: ECMO, assisted ventilation, exposure to ototoxic medications and jaundice requiring exchange transfusion.
  • In utero infections such as CMV, herpes, rubella, syphilis, and toxoplasmosis.
  • Craniofacial anomalies
  • Syndromes associated with hearing loss or progressive or late-onset hearing loss
  • Culture-positive postnatal infections
  • Head trauma, especially basal skull/temporal bone fracture that requires hospitalization.
  • Chemotherapy
  • Recurrent or persistent ear infections for at least 3 months.


How is objective screening done?


To prevent language disabilities and improve patient outcomes we use OAE Hearing Screener, child-friendly hearing screener that’s objective, accurate and easy to use. By requiring minimal patient cooperation, the OAE Hearing Screener lets us precisely and objectively screen for hearing loss in newborns, infants, toddlers, preschool and school-age children in just seconds.


With simple, intuitive operation and clear, easy-to-understand “pass/refer” reporting in a portable design, the OAE Hearing Screener helps the pediatrician to provide a comprehensive care for the patients.


Important Points:


  • Every child with 1 or more risk factors on the hearing risk assessment should have ongoing developmentally appropriate hearing screening and at least 1 diagnostic audiology assess between 24 to 30 months of age.
  • Periodic objective hearing screening of all children should be performed according to the recommendations for preventive periodic health care.
  • Any parental concern about hearing loss should be taken seriously and requires objective hearing screening of the patient.
  • Developmental abnormalities, level of functioning, and behavioral problems (i.e., autism/developmental delay) may preclude accurate results on routine audiometric screening and testing.
  • In this situation, referral to an ENT specialist and a pediatric audiologist who has the necessary equipment and expertise to test infants and young children should be made.
  • The results of abnormal screening should be explained carefully to parents, and the child's medical record should be flagged to facilitate tracking and follow-up.
  • Any abnormal objective screening result requires audiology referral and definitive testing.
  • A failed infant hearing screening or a failed screening in an older child should always be confirmed by further testing.
  • Abnormal hearing test results require intervention and clinically appropriate referral, including otolaryngology, audiology, speech-language pathology, genetics, and early intervention.



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