So Your Child has a Hearing Loss: What is Early Detection, and why is it important?

So Your Child Has a Hearing Loss: Next Steps for Parents

What is Early Detection, and why is it important?

Early detection simply means discovering a hearing loss at a very early age - hopefully in the first few days of life. Advances in research and technology have created the means for this to happen. Previously, children's hearing could only be tested by observing a child's behavioral responses to sounds. Today's automated hearing-screening machines do all of the work, so even a sleeping baby's hearing can be measured. Many hospitals now screen a newborn's hearing before he/she is discharged from the hospital. (The sidebar describes the types of hearing tests used with infants and young children.)

These early exams are referred to as "screenings" rather than "tests", because their results are not definitive. They can only screen out those babies who are likely to have a hearing loss from those likely not to have a hearing loss. If an initial screening comes back "positive", then a second screening and follow-up testing are performed to confirm whether a hearing loss is present and, if so, the type and nature of the loss.

In the hospital, nurses, aides, or other hospital personnel may do the screening, but the test interpretation and follow-up evaluation should be performed by an audiologist (i.e., someone with an advanced degree and appropriate licensure/certification in evaluating hearing). If a hearing loss is suspected, your pediatrician should refer your child to an ear, nose and throat doctor (otolaryngologist), to rule out any cause of hearing loss which could be medically or surgically corrected. Some parents also decide to seek genetic counseling because, of the many causes of hearing loss, some are hereditary. You may want to know whether you or your spouse carry a gene for hearing loss, or whether the hearing loss is part of a "syndrome" (cluster of symptoms), which may cause related medical problems.

The next step after the diagnosis is to find an audiologist whom you feel comfortable with, and who you feel confident will help you manage your child's hearing loss. It is entirely within your rights to "shop" for an audiologist by scheduling initial meetings with several practitioners. You can locate audiologists in your area by asking for referrals from your pediatrician and/or otolaryngologist, as well as by asking other parents of children with hearing loss who they use. When seeking an audiologist for your child, inquire whether your practitioner has experience working with pediatric patients and be sure to observe during your initial visits his/her level of rapport with your child. The American-Speech-Language-Hearing Association (ASHA) can refer you to an audiologist in your area via their Consumer Helpline (800-638-8255).

How Young Children's Hearing is Screened and Evaluated

Newborns and infants can be tested without their cooperation. There are two commonly used measures-both can be performed on a sleeping infant-that require no response from your baby and are not painful or uncomfortable.

ABR (Automated Brain Stem Response): Sounds are presented through earphones while the baby rests quietly or sleeps. Brainstem responses to sound are measured through small electrodes, which are taped on the baby's head. These responses are processed by a computer.

OAE (Otoacoustic Emissions): A small probe tip is inserted into the baby's ear canal. It measures the function of the inner ear, or cochlea.

Behavioral Testing: These types of tests are used when children are old enough to turn their head in response to sound, or play a game. These tests measure the quietest sounds your child can hear, your child's ability to understand words, and whether fluid or some other obstruction is present in the middle ear.

Acoustical Impedance tests can be administered to children of all ages and can help identify middle ear problems (e.g., presence of fluid and status of eardrum) through a non-invasive and computerized technique.

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