Hearing loss is one of the most frequently occurring congenital disabilities, affecting approximately three in 1,000 people. Without early detection and intervention, hearing impairment in infants and young children can negatively impact speech and language acquisition, academic achievement, and cognitive and social development. It is a potential source of liability for the patients’ physicians if the problem is not caught and addressed in a timely fashion. If detected and treated, however, these negative impacts can be greatly diminished and even eliminated through early intervention.
In 1993, the National Institutes of Health (NIH) recommended that all infants be screened for hearing impairment at birth, preferably prior to hospital discharge. Since then, there has been a rapid increase in the number of universal newborn hearing screening (UNHS) programs. CornerStone Ear, Nose, & Throat pioneered UNHS in our region by starting the first program in the Charlotte area in 1997, long before the state mandated this testing.
There are two types of hearing tests that are used to evaluate infant hearing:
- Otoacoustic emissions (OAE) measure the response of outer hair cells within the cochlea to a particular stimulus. The hair cells must be healthy to produce robust sound emissions, allowing us to know that the cochlea is working properly and hearing is within normal limits.
- Auditory brainstem response (ABR) testing measures the brain’s response to a “click” delivered through earphones, much like an EEG of the brainstem. Sensors measure the baby’s entire hearing pathway to determine if the sounds are heard normally.
Both tests are non-invasive and require no action by the patient (a key quality for a newborn test). Currently CornerStone Ear, Nose, & Throat performs all of the newborn hearing screenings at Atrium Health Union and provides follow-up testing and care for patients and their families across the Charlotte region. All infants who do not pass the original hearing screening in the hospital should be referred for re-screening or diagnostic testing. Ideally, audiological evaluations on infants who fail the newborn hearing screening should be performed before three months of age, or as soon as possible after discharge. Infants with confirmed hearing loss should receive early intervention services before six months of age.
Parents and health care providers should understand that a “pass” on the newborn hearing test does not rule out later development of hearing problems in infancy or early childhood. Speech and language development should be continuously monitored as an indicator of hearing difficulties. Infants who are at risk for progressive or late-onset hearing loss should be tested more frequently than those with no known hearing loss risks. These elevated risks may include, but are not limited to:
- Toxoplasmosis
- Syphilis
- Maternal Rubella
- Cytomegalovirus
- Hyperbillirubin
- Low birth weight
- Recurrent ear infections before three months of age
- Strong family history of congenital hearing loss
