Hearing screening

Authors

Kei J, Huening B, Wolke D, van Straaten HLM, Bloch VVH

Target group

Infants born very preterm or those infants with risk factors including severe hyperbilirubinemia, positive family history, syndromes and craniofacial/ear abnormalities (see preamble Follow-up & continuing care) and parents

User group

Healthcare professionals, neonatal units, hospitals, follow-up teams, and health services

Statement of standard

Standardised hearing screening is conducted using Automated Auditory Brainstem Response (AABR) technology before discharge, with continuous tracking and ongoing surveillance of infants who fail the screening, to ensure that, where necessary diagnostic investigations are completed before three months and early interventions are started within the first six months.

Rationale

The goal of this standard is to ensure screening and evaluation of hearing function in high-risk newborn infants and start auditory habilitation and follow-up for those infants with diagnosed congenital or early hearing impairment. (1–4)

Permanent childhood hearing impairment (PCHI) has a prevalence of 1 per 1000 live-born children, rising to 6 per 1000 at school age and is usually defined as hearing impairment of 30 dB or more in the better ear. (4–5) Even this relatively limited hearing loss will impair language and speech development with lasting consequences. (6–8) Social and emotional development and academic achievements will also be affected. (9–13)

When the hearing impaired child is identified shortly after birth and appropriate interventions are started before 6 months of age, with family counselling and amplification with hearing aids or cochlear implants for the child, the gains are enormous. (6,7,10,13) Studies have shown that this can enable a child who is deaf or severely hard of hearing to achieve better outcomes in language and speech development, very often within the normal range, with ultimately much improved social, academic, and work achievements in adult life. (9,13–15)

Monitoring and follow-up, especially in the pre-lingual period, is essential, for all children with hearing loss and especially those with risk factors for progressive or late onset hearing impairment. (16)

Benefits

Short-term benefits

Early detection and management of hearing loss (1–4)

Long-term benefits

Early counselling to engage parents in their child’s special needs (16,17)
Early initiation of interventions (3,4,8)
Improved use of various means of communication (e.g. visual, tactile, and other stimuli) with a hearing impaired child from the earliest possible age (16)
Improved parent-child interaction and bonding (18)
Prevented or reduced language and speech developmental problems (7,17)
Prevented or reduced social and emotional problems (9,12)
Improved chances for attending mainstream education with better academic achievements (6,8,10), as well as optimal study and training opportunities with prospects for better work and financial potentials (11)
Reduced societal and educational costs (14–15)
Increased quality of life of children, parents and families (19,20)
Broader medical investigations which might not otherwise be initiated. Hearing impairment is often associated with other disorders and occurs frequently as part of a specific genetic syndrome (21)
Provides feedback for perinatal and public health records (consensus)

Components of the standard

Component

Grading of evidence

Indicator of meeting the standard

For parents and family

Parents are informed about universal neonatal hearing screening, and invited and encouraged by healthcare professionals to participate. (4,5)

A (High quality)
B (High quality)

Patient information sheet¹

Parents receive standardised feedback about the results of their child’s hearing screening in language that is accessible to them.

B (Moderate quality)

Parent feedback

Parents of children with a ‘failed’ hearing screening outcome are invited and encouraged by healthcare professionals to attend diagnostic assessments regarding cause, type and degree of hearing loss within three months of birth. (4–5)

A (High quality)
B (High quality)

Clinical records, guideline, patient information sheet¹

Parents of children with permanent childhood hearing impairment (PCHI) are invited and encouraged by healthcare professionals to begin interventions including family guidance and amplification for the child as early as possible after diagnosis, certainly within six months of birth. (4,17)

A (High quality)
B (High quality)

Guideline, patient information sheet¹

Parents have the opportunity to have contact with other parents of young children with hearing loss.

B (Moderate quality)

Patient information sheet¹

Parents are asked for permission to allow their child’s medical and educational information to be used for outcome measures.

B (Low quality)

Parent consent, patient information sheet¹

Parents are asked to consent to share the results of their child’s hearing screening tests with education providers.

B (Moderate quality)

Parent consent

For healthcare professionals

A guideline on hearing screening of all newborn infants using an appropriate validated objective screening method within one month of birth, or term equivalent age as well as gold standard audiological diagnostic investigations to evaluate the type and degree of hearing impairment when the hearing screening is not “passed” by the screening method is adhered to by all healthcare professionals. (4)

A (High quality)
B (High quality)

Guideline

The screening method used is appropriate to the child and situation, e.g. very preterm infants are screened using AABR because of the risk of retrocochlear pathology. (3,4,22)

A (High quality)

Audit report², guideline

Training on hearing screening and gold standard audiological diagnostic assessments used to evaluate the type and degree of hearing impairment when the hearing screening is not “passed”, is attended by all responsible healthcare professionals (screeners). (3,4,22)

A (High quality)
B (High quality)

Training documentation

A guideline on diagnostic evaluation and early interventions to be started as early as possible after the diagnosis of hearing impairment and certainly before the age of 6 months, as well as on appropriate and adequate follow-up of children with hearing loss (including late-onset types) is adhered to by all healthcare professionals. (3,4,16)

A (High quality)
B (High quality)

Guideline

For neonatal unit, hospital, and follow-up team

A guideline on hearing screening and referral for further interventions where necessary is available and regularly updated. (4)

B (High quality)

Guideline

Appropriate screening facilities and screeners are provided in hospitals where infants are born or admitted during the first weeks of life and also, when appropriate, in public health child services. (3-4)

A (High quality)
B (High quality)

Audit report²

Training on hearing screening and gold standard audiological diagnostic assessments used to evaluate the type and degree of hearing impairment when the hearing screening is not “passed”, is ensured.

B (High quality)

Training documentation

For health service

A national guideline on universal neonatal hearing screening and referral for further interventions where necessary is available and regularly updated.

B (High quality)

Guideline

A national legal framework and funding is provided for hearing screening, diagnostic investigations, auditory habilitation, education, care, and follow-up. (3-4)

A (High quality)
B (Moderate quality)

Legal framework

¹The indicator ‘patient information sheet’ is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.

²The indicator ‘audit report” can also be defined as a benchmarking report.

Where to go

Further development

Grading of evidence

For parents and family

Ensure that parents who are deaf or severely hard of hearing themselves are sufficiently supported by a case manager and speech-to sign language interpreters and all other necessary communication methods.

B (High quality)

Provide funding to allow parents who are socially disadvantaged to participate in the follow-up hearing evaluations and interventions.

B (High quality)

For healthcare professionals

If required, provide sign interpreter.

B (Moderate quality)

For neonatal unit, hospital, and follow-up team

N/A

For health service

Evaluate and institute very early amplification. (23)

A (High quality)

Establish a statewide data management system for tracking and ongoing surveillance of infants who fail the screening.

A (High quality)

Getting started

Initial steps

For parents and family

Parents are informed about the availability of neonatal hearing screening facilities and the importance of attending, and when necessary, also attending for diagnostic investigations after a ‘failed’ screen result.

For healthcare professionals

Attend training on hearing screening and gold standard audiological diagnostic assessments used to evaluate the type and degree of hearing impairment when the hearing screening is not “passed”.
Promote awareness of the devastating effects of congenital and early childhood hearing impairment and the significant benefits of early detection and habilitation of hearing impairment.
Use any available tool to test hearing in a standard way for screening.

For neonatal unit, hospital, and follow-up team

Develop and implement a guideline on neonatal hearing screening.
Develop information material on neonatal hearing screening for parents.
Provide a service to perform standardised hearing screening.
Support healthcare professionals to participate in training on neonatal hearing screening.
Provide a service to perform standardised hearing screening.

For health service

Develop and implement a national guideline on universal neonatal hearing screening.
Work towards having facilities in place for those who fail the screening with adequate and appropriate diagnostic and habilitation facilities available for all.

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