Do Babies Who Pass Newborn Hearing Screening Need to Be Tested Again?

Normal hearing kids

Babies who pass newborn hearing screening are usually released from follow-up. It is assumed that if the baby had normal hearing at birth the child is out of the woods, as they say. But is that so? Usually it is. But not always.

 

Middle ear disease

Most kids develop fluid in the middle ear, with or without ear infections, at some time in their lives. Some kids develop only a few infections and others have them almost constantly. Some develop hearing loss along with the ear infection and others do not. For those who do not develop a hearing loss, the middle ear disease needs to be treated, but not much else matters. For a child whose hearing is compromised when he gets middle ear disease, the hearing loss can last as long as 6 weeks.

I did some research a number of years ago which demonstrated that some children with hearing middle ear disease had reduced speech perception along with the middle ear disease{{1}}[[1]]Madell, J. R.: (1999), Impact of Otitis Media on Auditory Function, in Evidence-Based Otitis Media, Richard M. Rosenfeld and Charles D. Bluestone, Editor, B.C. Decker Inc., Hamilton, London, Saint Louis, 21, 337-351)[[1]]. I participated in another study which showed that parents cannot recognize mild hearing loss in their children{{2}}[[2]]Brody R, Rosenfeld RM, Goldsmith AJ, Madell JR. Parents cannot detect mild hearing loss in 2008 children. First place–Resident Clinical Science Award 1998. Otolaryngol Head Neck Surg. Dec 2009 1999;121(6):681-686)[[2]]. So, if parents cannot tell if a hearing loss is present, and if middle ear disease can cause speech perception problems, what does this mean? To me it means that any child who has more than a very occasional middle ear disease needs to have hearing tests.

 

Progressive hearing loss

Fortunately, the great number of children who pass their hearing screens continue to have normal hearing. But not all. We know that there are children who have normal hearing at birth but then develop a hearing loss in the first few years of life{{3}}[[3]]Madell, J.R. and Sculerati, N.: (1991) Non Congenital Hereditary Hearing Loss in Children; Archives of Otolaryngology, , 117, 332‑335[[3]]. We know that many children with hearing loss have hearing drops in hearing over time. So what can we conclude from this? Children need hearing tests.

 

How often should kids be tested.

There will certainly be differences of opinion about this question so I will just give you mine. Normal hearing kids who are developing good speech and language should have hearing tests at about 7-9 months and then annually until about age 5. By then, if a child is doing well, it is likely that any developing hearing loss will be identified.

Children identified with middle ear disease should have hearing testing when middle ear disease is identified and after the middle ear disease is resolved to be sure that hearing is back to normal.

 

School hearing screening

Typically developing children should be tested in school, ideally, every year in the early years and then every two years. In some school settings this may happen, but in many school districts, hearing screening is conducted only occasionally. And sometimes, as in one school district I recently visited, school hearing screening was conducted by parents. Not ideal. Screening should be conduced by or under the supervision of hearing professionals. Our kids deserve at least this.

About Jane Madell

Jane Madell has a consulting practice in pediatric audiology. She is an audiologist, speech-language pathologist, and LSLS auditory verbal therapist, with a BA from Emerson College and an MA and PhD from the University of Wisconsin. Her 45+ years experience ranges from Deaf Nursery programs to positions at the League for the Hard of Hearing (Director), Long Island College Hospital, Downstate Medical Center, Beth Israel Medical Center/New York Eye and Ear Infirmary as director of the Hearing and Learning Center and Cochlear Implant Center. Jane has taught at the University of Tennessee, Columbia University, Downstate Medical School, and Albert Einstein Medical School, published 7 books, and written numerous books chapters and journal articles, and is a well known international lecturer.