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Key messages

  • Approximately 1 in every 1000 babies will have a permanent hearing loss in both ears at birth that is moderate, severe or profound. Newborn hearing screening aims to identify babies born with a hearing impairment regardless of whether they are at risk. It is based on well- established research evidence that the earlier a hearing loss is identified, the better the outcome for the child.
  • The hearing screen is not a diagnostic test; therefore any baby that does not receive a 'pass' result requires referral for a diagnostic audiology assessment. 
  • The technology used in newborn hearing screening is quick, easy and reliable, and the results can be provided to families immediately.

Please note that all guidance is currently under review and some may be out of date. We recommend that you also refer to more contemporaneous evidence in the interim.

Currently, in Victoria, approx. 78 babies are born each year with a moderate or greater, permanent congenital bilateral hearing impairment.

Universal newborn hearing screening (UNHS) programs are now widely available in Australia and internationally and has led to measurable improvements in the early detection of hearing loss. The average age of detection pre-introduction of hearing screening in 1989 was 20.3 months and by 2014 had reduced to 0.8 months.

As a result, improvements in language, education, social and emotional development have been observed in this population. 

Screening test procedure

In Victorian hospitals, the screening technology used is an Automated Auditory Brainstem Response (AABR). 

The AABR is a fully automated screen that requires no interpretation of data by the operator. The screen is painless and non-invasive for the baby. Both ears can be checked simultaneously with an average screening time of about four to seven minutes. 

How the fully automated screening test works:

  • The baby’s ears are covered with single-use adhesive ear couplers which then emit a series of soft clicking sounds.
  • There are three sensor tabs that are placed on the baby’s neck, shoulder and forehead which measure the auditory nerve (8th nerve) activity in response to the sound played. 
  • The AABR unit completes a statistical calculation based on the responses recorded to determine the screen result.
     
    Figure 1: ABR screening
    Figure 1: Automated Auditory Brainstem Response (AABR) 

    For more information see Victorian Infant Hearing Screening Program 

All babies born in maternity hospitals are screened

The Victorian Infant Hearing Screening Program (VIHSP) provides statewide newborn hearing screening to babies born at all Victorian maternity hospitals.

VIHSP aims to perform a hearing screen on all babies by 1 month of corrected age. Most babies are screened as an inpatient within the first two days after they are born.

The screen can also be done in an outpatient setting if a baby is discharged prior to being screened. A baby can be as young as 6 hours of age for the screen to be undertaken.

The hearing screen can be performed on premature babies (34 weeks corrected age or greater), and those admitted to the Intensive and Special Care Nursery.

The hearing screen for NICU/SCN baby is performed close to discharge.

Some states use different tests

In some states, an alternative form of hearing screening is performed using Transient Evoked Otoacoustic Emissions (TEOAE). 

In this test otoacoustic emissions evaluate the integrity of the outer hair cells within the cochlea. The testing is performed by placing a probe in the external ear canal that emits soft sounds to stimulate the cochlear. Within this probe is a sensitive microphone that is able to detect any outer hair cells auditory response to this initial stimulus. The recorded response must be a certain strength in order to pass this screen. 

Risk factors for hearing loss

Any risk factors for progressive or acquired permanent hearing loss are identified at the time of the hearing screen and are reviewed by a maternal and child health nurse, paediatrician or GP.    

Immediate follow up by an audiologist is recommended if any of the following risk factors apply, even if the baby has passed the VIHSP:

  • Significant head injury
  • Congenital abnormality of the head and neck
  • Meningitis/ encephalitis

Follow up by an audiologist is recommended at 8-12 months if any of the following risk factors are present:

  • close family history of congenital hearing impairment (parent / sibling)
  • Parental concern regarding the child’s hearing
  • Neurodegenerative disorder
  • syndrome known to be related to hearing loss (eg Down Syndrome, Usher Syndrome, Waardenburg Syndrome)
  • Congenital infections during pregnancy eg: HIV, TORCH - (Toxoplasmosis, Other (syphilis, varicella), Rubella, CMV, Herpes)
  • ventilation > 5 days (excluding CPAP)
  • amino glycoside antibiotic therapy (eg gentamicin) for 3 or more consecutive days
  • jaundice requiring an exchange transfusion or at exchange level.

Referral to audiology

A positive or a ‘refer’ result on the VIHSP hearing screen indicates a need for a diagnostic audiology assessment, which is conducted by an audiologist. The aim of the assessment is to get a complete picture of the baby’s hearing at that time.

Ideally the audiology assessment should take place when the baby is four to six weeks of age, to ensure they commence early intervention and use of amplification devices as soon as possible, if required. 

The audiology assessment referral following a 'refer' result is made by the VIHSP area manager for that hospital. The manager will contact the family and make an appointment for the baby. 

The referral/appointment is made to an audiology centre that is most convenient for the family. 

VIHSP early support services are available to families whose baby obtains a 'refer' result on the newborn hearing screen. The early support facilitator will also talk to the family once a diagnosis has been made, helping them understand their options and other support services available following the baby’s diagnosis of a hearing loss.

When a baby presents with one or more risk factors for hearing loss that require immediate referral or a referral at 8 – 12 months of age, the audiology assessment referral is the responsibility of the nurse or medical practitioner who identifies the risk factor.

Audiology referrals can be made using the VIHSP Audiology Referral Form.

More information

Consumer

References

  • Russ SA, Poulakis Z, Barker M, Wake M, Rickards F, Saunders K, Oberklaid F. (2003) Epidemiology of Congenital Hearing Loss in Victoria, Australia, Int J Audiology; 42: 385-390
  • Stevens Wrighton, A. (2007) Universal Newborn Hearing Screening. American Family Physician. Vol 75, No. 9.

Get in touch

Centre of Clinical Excellence - Women and Children
Safer Care Victoria

Version history

First published: September 2016

Last reviewed: February 2017

Review by: September 2019

UNCONTROLLED WHEN DOWNLOADED

Page last updated: 17 Feb 2021

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