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Welcome to the Newborn Hearing Screening Parent Page. This page is parents or caregivers whose newborns have not passed their initial hearing screenings or diagnostic hearing tests. Here you will find two sections with information on the newborn hearing screening process, including a quick startthat will show you the immediate steps that should be taken during a newborn’s hearing testing. Also found on this page are sections on services, risk factors, and other information.

 

Note: You will see blue text throughout these pages. These are links that will take you directly to that topic. Use your browser’s “back button” to return to the previous page.

 

 

Parent Page Table of Contents:

Section 2. DETAILS

   The Parts of the Ear

   The Newborn Hearing Screening Process

   Screening Tools and Methods

   Services

   Risk Factors

   Developmental Milestones

   Links, Resources, and Forms

 

 

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SECTION 1. QUICK START   

 

 

Step 1 - Initial Hearing Screening - The “initial hearing screening occurs within one or two days of birth. If there are no medical concerns, your newborn has probably already had their initial hearing screening in accordance with state law. Parents only need to verify the screening has taken place before leaving the birth hospital. If your child did not pass this screening, please see Step 2, “rescreen”, immediately below.

 

Step 2 - Rescreen - If your newborn did not pass the initial hearing screening, as discussed above, they will be given a second hearing screening often called a “rescreen.” If your child did not pass the rescreen, then please see “diagnostic evaluation” immediately below.

 

According to a new law that takes effect January 1, 2016, any newborn who does not pass the "rescreen" will also be given a simple and painless test to determine if cytomegalovirus (CMV) is present. For more information please see: CT EHDI CMV.

 

 

Step 3 - Diagnostic Evaluation - If your newborn did not pass the hearing rescreen, then a “diagnostic evaluation should be scheduled with an audiologist. The diagnostic evaluation is a more extensive hearing test using specialized equipment and protocols. It is also the only way to know for sure if your child has a hearing loss. It is strongly recommended that an appointment for the diagnostic evaluation be scheduled before the newborn leaves the birth hospital. Current guidelines recommend the diagnostic evaluation take place two to four weeks after the second screening, with respect to other medical concerns. It may be helpful if you bring copies of the hearing screening results to the audiological exam.  

 

 

Step 4 - Hearing Loss is Identified - If after having a diagnostic evaluation, your child has been diagnosed with a hearing loss, it is recommended to:

  • Schedule an appointment with an Ear, Nose, and Throat (ENT) doctor to assess the child. In some cases, the ENT may be able to identify a cause, or partial cause, of hearing loss. For more information, please see: ENT Visit Tips, and please visit the  AAO-HNS website. It may also be helpful if you bring copies of the diagnostic evaluation results to the ENT visit. 
  • Schedule an appointment with an ophthalmologist (eye doctor) too. Eye health is critically important to those with hearing loss. 
  • Consider genetic testing for children with hearing loss.  50% - 60% of permanent hearing loss is genetic, and testing may help determine the cause of the hearing loss or any other hidden problems. Genetic testing can be important even if hearing loss does not run in the family. For more information, please see the "Genetics Information" section on the Provider Page.
  • See Step 5 - Services, below. 

 

Step 5 - Services (There is Help Available!)  - If a hearing loss is present, there is help available. An organization called the Connecticut Birth to Three System may be able to assist you with services. Many children with hearing loss are eligible for services. For more information on services available, please visit their website for more information: Connecticut Birth to Three System

To refer a child to Connecticut Birth to Three, there are two options:

  • To refer a child directly to Connecticut Birth to Three, please click here: on-line referral.
  • Or, you may call: 1-800-505-7000 (TTY: 800-671-0737) This number is for the  Child Development Infoline. They will assist you with a referral to Birth to Three.

If your child is eligible, a Connecticut Birth to Three service coordinator will work with your family to develop a plan of service. 

The earlier a child with a hearing loss is identified, and interventions started, the less impact the hearing loss will have on the child’s speech and language development. 

Quick Resources  

  • Parent Flowchart (A flowchart to help parents navigate the hearing screening process)
  • NEW - "Your Baby Needs Another Hearing Test \ About Cytomegalovirus".  Note - This brochure is meant to be printed and folded in half, then folded in half again, not read on screen. We are working on a screen-friendly version for parents and will post it here once complete. Also, a Spanish version will be made available in the future.
  • Hands and Voices  (Connecticut Chapter) - Hands & Voices is dedicated to supporting families with children who are deaf or hard of hearing without a bias around communication modes or methodology. They are a parent-driven, non-profit organization providing families with the resources, networks, and information they need to improve communication access and educational outcomes for their children. Their outreach activities, parent/professional collaboration, and advocacy efforts are focused on enabling Deaf and Hard-of-Hearing children reach their highest potential. 
  • Guide By Your Side  - Guide By Your Side (GBYS) ™ is a free program from Hands & Voices (H&V) that provides emotional support and unbiased information from trained Parent Guides to other families and to the systems that serve them. GBYS is a trademarked program of H&V that is available to authorized H&V chapters and approved agencies via an application process. GBYS has been created to be a flexible program that will meet the unique family support and outreach needs of Connecticut. For more information on GBYS services available in Connecticut please contact Tammy Breard at : tbreard@cthandsandvoices.org or 860-255-8468 (voice\text).    
      
      For additional resources, please see: The Links, Resources, and Forms page.             
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SECTION 2. DETAILS  

 

For those who want to know more about the subject.

 

 

Contents:

Screening Tools and Methods

Services

Risk Factors

Developmental Milestones

Links, Resources, and Forms  

      

 

THE PARTS OF THE EAR  

Knowing the different parts of the ear will help you when speaking with your child's audiologist or doctors. 

  • Outer Ear: The outside of the ear, plus the ear canal up to the eardrum or tympanic membrane.
  • Middle Ear: The cavity behind the tympanic membrane which houses three small bones that help conduct sound waves to the inner ear.
  • Inner Ear: The cavity behind the middle ear houses a series of channels known as the labyrinth, and a snail-shaped structure called the cochlea. The labyrinth is integral to the human balance system. The cochlea contains the thousands of nerves responsible for sensing sound and transmitting it to the brain for processing.
  • Auditory Nerve: The eighth cranial nerve, which is the pathway of sound from the ear to the brain.

{ear diagram}

  The Parts of the Ear Text and image Courtesy of the Laurent Clerc National Deaf Education Center  

 

 

 
 
As mentioned on the home page, legislation requiring all Connecticut birth facilities to implement a universal newborn hearing screening program took effect on July 1, 2000. As a result, all infants born in Connecticut are screened for hearing loss at birth, unless the parent refuses due to religious beliefs. 
 
The testing process can be broken down into two parts:
 
1. Screenings
 
Initial Hearing Screening - This is the first test, or screening, your child will have for hearing loss. It is normally conducted at the birth hospital within one to two days of being born. The initial screening methods used can be either otoacoustic emissions (OAE) or auditory brainstem response (ABR), depending on the hospital the infant is born in. Both tests are painless and they measure a newborns ability to hear. Either test may be used for the initial screening.                                                                                                                         
Rescreen Fluid in the ear, the baby moving during the testing, noise in the testing area, or an actual hearing loss may have caused your baby to fail the initial screening. The “rescreen” is similar to the initial screening, but it is used to confirm or deny the initial screening results. It is also recommended that the rescreen be conducted using an ABR. If your baby does not pass the rescreen, the only way to determine if there is a hearing loss is with a diagnostic evaluation.
 
 
CMV - According to a new law that takes effect January 1, 2016, any newborn who does not pass the "rescreen" will also be given a simple and painless test to determine if cytomegalovirus (CMV) is present. For more information please see: CT EHDI CMV.
 
 
2. Diagnostic Evaluation
   
Diagnostic Evaluation This is a series of tests that are done by an audiologist (a person trained to test hearing) using specialized equipment. The testing will determine your baby’s ability to hear sounds. The diagnostic testing should be performed by an audiologist who specializes in working with infants and has the training and equipment necessary to conduct complete diagnostic testing. At the time of the diagnosis, the audiologist may refer an infant, with diagnosed hearing loss, to the Connecticut Birth to Three System for determination of eligibility for services.
  
 
As mentioned above, there are two basic types of screening tools used by Connecticut birth facilities for an initial screening or a rescreening: the OAE and ABR. Both methods are recommended for the initial screening, however, only the ABR is recommended for the rescreen. The diagnostic evaluation also may use the OAE or ABR, but also uses other tools or methods.

 

{oae}
OTOACOUSTIC EMISSIONS
 

OAE - The otoacoustic emissions (OAE) method uses tiny sound emitting earplugs that are placed in the infant’s ears, and then sound waves are used which bounces off the infant’s cochlea and the response to the sound is recorded. The otoacoustic emissions method is very sensitive to fluid or other debris, which may be in the ear canal. In order to obtain accurate results it is extremely important not to screen the baby too soon after birth, to ensure a relatively clear ear canal and proper probe fit as well as making sure the infant is in a quiet state.

If an infant does not pass the initial hearing screening, they should be rescreened, before leaving the birth facility, using the ABR method. If the infant does not pass the rescreen, a diagnostic evaluation should be scheduled before the infant leaves the hospital. All neonatal intensive care unit (NICU) babies should have the hearing screening done using the ABR method.

The hearing screen should be done in the hospital before the baby goes home.

 

{ABR}
AUTOMATED AUDITORY BRAINSTEM RESPONSE  
 

ABR - The second screening method is Automated Auditory Brainstem Response (ABR or AABR). Earphones that emit sound are placed on the infant’s ears. Soft electrodes are placed on the infant’s forehead, neck, and/or shoulder and record the auditory nerve response to the sound.

Both methods use a computer to interpret the infant’s response to the sound and generate a screening result. The screenings are relatively quick and painless and are usually conducted when the infant is sleeping or in a quiet state. The infant’s parent can request to be present during the screening. Results are recorded as "pass" or "refer". A refer means the child did not pass the test.

Diagnostic Evaluation – The “diagnostic”, as it is often referred to, uses a comprehensive battery of tests and observations to make an assessment, and may make use of the OAE and ABR, in addition to several other tools. For more specific information about the types of tests that could be used to make Diagnostic Evaluations, please visit the National Center for Hearing Assessment and Management website at: http://www.infanthearing.org/audiology/index.html , or speak with your audiologist.

Any audiologist accepting infants for initial audiological evaluations should have the equipment, training, and skills to complete the tests recommended by the Connecticut Early Hearing Detection and Intervention Task Force. For a list of diagnostic testing centers, please see: Connecticut Infant Diagnostic Testing Locations and Best Practices Recommendations.

It is important to note that both ears should be tested during the diagnostic evaluation, regardless of whether one ear passed the initial screening.

After a child has been diagnosed with a hearing loss, it is recommended that an appointment be  scheduled with an Ear, Nose, and Throat (ENT) doctor to assess the child. In some cases, the ENT may be able to identify a cause or partial cause for the loss. For more information, please see: ENT Visit Tips and AAO-HNS.

Also, if a child has a diagnosed hearing loss, eye health is critically important; therefore it is recommended an appointment with an ophthalmologist is scheduled too.

Finally, 50% - 60% of permanent hearing loss is genetic; therefore parents may want to consider genetic testing for their child with hearing loss. Genetic testing helps to find the cause of the hearing loss or any other hidden problems. Genetic testing can be important even if you do not know of any family members who have a hearing loss. For more information, please see the Genetics Information section on the Provider Page.

Note - Once you begin the testing process with your child, it would speed things along, and be helpful to the medical staff, if you brought copies of your child's hearing screening results, diagnostic evaluation, and their ENT diagnosis to all hearing related appointments.  

 

TYPES and CAUSES of HEARING LOSS                                                                                            

The type of hearing loss depends upon where in the ear the problem occurs. The three main types are conductive, sensorineural, and mixed losses.

Conductive: A problem in the outer or middle ear may cause conductive hearing loss. A conductive loss prevents sound from reaching the nerves in the inner ear. Common causes include:
  • Conditions associated with middle ear pathology such as fluid in the middle ear from colds, allergies, poor Eustachian tube function, ear infection, perforated eardrum, benign tumors.
  • Impacted earwax.
  • Infection in the ear canal.
  • Presence of a foreign body.
  • Absence or malformation of the outer ear, ear canal, or middle ear.

Sensorineural: Damaged nerves in the inner ear cause sensorineural hearing loss. Sensorineural losses cannot be reduced or eliminated by surgery. There are many causes, differing by age of onset.

Before or During Birth:

  • Perinatal infections such as rubella, herpes, toxoplasmosis, syphilis, cytomegalovirus (CMV).
  • Heredity.
  • Asphyxia or lack of oxygen at birth.
  • Possible association with birth weight of less than 1500 grams.
  • Possible association with defects of the head and neck.

Later Onset:

  • Bacterial meningitis.
  • Ototoxicity (drug induced).
  • Intense or excessive noise.
  • Physical damage to head or ear.


Mixed: Sometimes, people will have problems both in the inner ear and in the outer or middle ear. This type of hearing loss is known as a mixed loss.

Types and Causes of Hearing Loss - Courtesy of Laurent Clerc National Deaf Education Center  

                        

SERVICES

 As mentioned above, the audiologist will refer any infant diagnosed with a hearing loss for early intervention services at the time of diagnosis. Parents or care givers may also refer a child to Connecticut Birth to Three System  for determination of eligibility of intervention services.

To refer a child to Connecticut Birth to Three, there are two options:

  • Or, you may call: 1-800-505-7000 (TTY: 800-671-0737)This number is for Child Development Infoline. They will assist you with a referral to Birth to Three.  

If your child is eligible, a Connecticut Birth to Three service coordinator will work with your family to develop a plan of services. 

The earlier a child with a hearing loss is identified, and interventions started, the less impact the hearing loss will have on the child’s speech and language development. 

 

Hands and Voices  (Connecticut Chapter) Hands & Voices is dedicated to supporting families with children who are Deaf or Hard of Hearing without a bias around communication modes or methodology. They are a parent-driven, non-profit organization providing families with the resources, networks, and information they need to improve communication access and educational outcomes for their children. Their outreach activities, parent/professional collaboration, and advocacy efforts are focused on enabling Deaf and Hard-of-Hearing children reach their highest potential.   

 

Guide By Your Side  - Guide By Your Side (GBYS) ™ is a free program from Hands & Voices (H&V) that provides emotional support and unbiased information from trained Parent Guides to other families and to the systems that serve them. GBYS is a trademarked program of H&V that is available to authorized H&V chapters and approved agencies via an application process. GBYS has been created to be a flexible program that will meet the unique family support and outreach needs of Connecticut.      

      For additional resources, please see: The Links, Resources, and Forms page.

RISK FACTORS

Babies with any of the following risk indicators, regardless of the status of their hearing screening result prior to discharge, should have more frequent monitoring of their audiological status. An audiologist experienced in working with infants and young children should conduct the follow-up testing. Speak with your doctor. 

  • Caregiver concern* regarding hearing, speech, language or developmental delay.    
  • Family history* of Permanent Congenital Hearing Loss (PCHL).
  • Hyperbilirubinemia requiring exchange transfusion.
  • In-utero infections such as: cytomegalovirus*, herpes, rubella, syphilis, and toxoplasmosis.
  • Craniofacial anomalies, including those involving the pinna, ear canal, ear tags, ear pits, and   temporal bone anomalies.
  • Physical findings such as white forelock, associated with a syndrome known to include a sensorineural or permanent conductive hearing loss.  
  • Syndromes associated with hearing loss or progressive or late onset hearing loss* such as: Neurofibromatosis; osteopetrosis; Usher; Waardenburg; Alport; Pendred; and Jervell and Lange-Nielson syndromes.    
  • Neonatal Intensive Care for more than 5 days, including any of the following: extracorporeal membrane oxygenation (ECMO)*, assisted ventilation, or exposure to ototoxic medications (gentamycin and tobramycin) or loop diuretics (furosemide/lasix).   
  • Culture positive postnatal infections associated with sensorineural hearing loss* such as:   confirmed bacterial and viral (especially herpes viruses and varicella) meningitis.    
  • Head trauma, especially basal skull/temporal bone fracture* requiring hospitalization.    
  • Chemotherapy* as used in cancer treatment.
  • Neurodegenerative disorders*, such as Hunter syndrome, or sensory motor neuropathies, such as Friedreich’s ataxia and Charcot-Marie-Tooth syndrome.

* Are of greater concern for delayed onset hearing loss.

Source:  Adaptation from the Joint Committee on Infant Hearing 2007 Position Statement

 

DEVELOPMENTAL MILESTONES CHECKLIST

Remember, passing a hearing test means that your baby’s hearing is normal at the time of the testing. A hearing loss can develop over time, for many reasons, so it is very important for parents and caregivers to be aware of the list of developmental goals found below. If at any time you have concerns about your child’s speech or hearing, talk to your baby’s doctor about having his/her hearing tested. The following list approximates where the typical child’s developmental goals would be during the noted age group.

 

Birth - 3 Months

• Is startled by loud sounds.

• Is soothed by caretaker’s voice.

 

3 - 6 Months

• Reacts to the sound of your voice.

• Turns eyes and head in the directions of the source of sounds.

• Enjoys rattles and noisy toys.

 

7 - 10 Months

• Responds to his/her own name.

• Understands “mama,” “dada,” “no,” and “bye-bye”.

• Turns head toward familiar sounds, such as dog barking, a telephone, and a person’s voice.

 

10 - 15 Months

• Imitates and matches sounds.

• Locates or points to familiar objects when asked.

• Understands and responds to simple questions, such as “Where’s the dog?”

 

15 - 18 Months

• Identifies things in response to questions, such as parts of the body.

• Uses a few single words; while not complete or perfectly pronounced, the words should be clearly meaningful.

• Follows simple spoken directions.

 

2 Years

• Understands yes and no questions.

• Enjoys being read to and shown pictures in books; points to pictures upon request.

• Likes radio or television.

• Puts words together to make simple sentences, such as “Juice all gone” or “Go bye-bye car.”

• Follows simple commands such as “Bring me that ball.”

 

2 ½ Years

• Says or sings short rhymes and songs and enjoys music.

• Knows about 270 words.

 

3 Years

• Understands and uses simple verbs, pronouns and adjectives:

- Go, come, run, and sing.

- Me, you, him, and her.

- Big, green, and sweet.

• Often uses complete sentences.

• Knows about 1000 words.

 
For a complete list Please see: The “Listen Up” Speech, Hearing, and Behavior Checklist for Parents Pamphlet: English or Español

 

 

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Content Last Modified on 1/14/2016 11:46:52 AM