Newborn Hearing Screening: Information & Specialists

About 2 to 3 out of every 1,000 newborns are born with hearing loss that requires treatment. This makes hearing loss the most common congenital sensory impairment. However, effective treatment methods are available. Therefore, congenital hearing loss detected early can usually be effectively managed.

Treatment should begin as early as possible. Only then can the physiological phases of auditory pathway maturation and spoken language development be optimally utilized.

Depending on the severity of the hearing impairment, the consequences of untreated hearing loss include 

• impaired or absent spoken language development and
• cognitive, emotional, or psychosocial disorders.

Early detection therefore plays a key role in the therapy and (re)habilitation of congenital hearing loss. Newborn hearing screening is thus of great importance.

Without early diagnosis, hearing loss requiring treatment is usually not detected until the age of two and a half years or later. For this reason, there is now a nationwide early detection program and a tracking system in place.

In 2004, the initial suspicion of a hearing impairment arose at an average age of 27 months. Confirmation by a specialist was received at 36 months of age. Mild or unilateral hearing impairments are often not detected until the pre-school medical examination.

In many cases, several more months pass before therapy begins. In 2004, therapy began on average at 38 months of age. As a result, treatment often did not begin until after the optimal window for therapy had passed.

Without newborn hearing screening, hearing impairments are generally detected too late—for example, only when parents notice that their child speaks less or less clearly than other children.

However, healthy hearing is a prerequisite for many developmental processes, especially for normal spoken language development!

The later a hearing impairment is detected and treated, the more severe its effects become. Early treatment can ensure that the child gets off to an optimal start in language development.

Hearing disorders can be reliably detected in the first few days after a child’s birth using a painless hearing test. An automated measuring device is used for this purpose

In 2009, universal newborn hearing screening was introduced in Germany. This marked a decisive step toward the early detection and treatment of hearing impairments in children during the first six months of life.

To provide optimal support for the implementation of newborn hearing screening, some federal states have established hearing screening centers. These centers are responsible for supporting children and parents through the so-called “tracking” process. The goal is to definitively assess the child’s hearing ability at a specialized pediatric audiology center. If necessary, treatment and support are also initiated there.

Newborn hearing screening is performed using objective hearing test procedures in the first few days after birth. Automated testing devices are used. The procedure is non-invasive for the child.

1. TEOAE = Transiently Evoked Otoacoustic Emissions (sound emissions from the inner ear):

A small probe is inserted into the baby’s ear, through which a rapid series of soft test tones is played. In response, a normally functioning inner ear emits faint sounds (otoacoustic emissions, TEOAE) that travel back into the child’s external auditory canal. These are recorded there using a sensitive measuring probe.

If these emissions are detectable, it indicates that the middle ear and cochlea are functioning properly, all the way down to the sensitive sensory cells (outer hair cells).

Fig. 1: Baby undergoing TEOAE screening

2. AABR measurement = Automated auditory brainstem response (brainstem responses to sound stimuli):

In this measurement method, the baby is also presented with soft sound stimuli via the probe. Three small electrodes detect the resulting nerve impulses in the area of the auditory nerve and the lower brainstem and evaluate them.

This makes it possible to assess the auditory system above the sensory cells of the cochlea, in the region of the auditory nerve and the brainstem. If these responses to stimuli can be reliably detected,

• middle ear,
• cochlea,
• auditory nerve, and
• the lower sections of the central auditory pathway at the brainstem level

are functioning. These signals are referred to as AABR. This makes it the most reliable hearing test method that can be used at this stage.

Fig. 2: AABR measurement in a newborn

Newborn hearing screening is conducted at the birth facility using either a one-stage or two-stage approach.

Two-stage hearing screening:

• Stage 1: TEOAE: for healthy newborns
• Stage 2: AABR: for all at-risk infants, as well as all infants with abnormal TEOAE results

TEOAE measurements are performed on healthy newborns. If these measurements repeatedly show abnormalities, a follow-up AABR test is conducted.

An AABR test is always performed on all at-risk infants. At-risk infants include, for example, babies receiving intensive care or those with additional medical conditions. These infants may have an increased risk of disorders affecting the auditory nerve and brainstem.

Single-stage hearing screening:

• Stage 1: AABR for healthy newborns and at-risk infants

An AABR test is performed on all newborns, regardless of whether they were born at term or have risk factors.

Both test procedures are easiest and quickest to perform while the baby is asleep. They are painless and have no side effects.

If the results indicate a need for further evaluation, it is important not to delay. The child will then require a prompt, professional follow-up examination at a qualified facility.

The screening device displays its results as either “normal” or “needs follow-up.” If “normal” appears on the screen, everything is fine. If “needs follow-up” appears, a follow-up examination is required at the birth facility. If the baby is flagged as “needing follow-up” upon discharge from the hospital, the baby needs a prompt, professional follow-up examination at a qualified pediatric audiology facility.

Parental Consent and Screening ID for Hearing Screening

At the birthing facility, parents are informed both by the staff and through a written parent information sheet.

Parents must first consent to the hearing screening and/or data storage in accordance with all data protection regulations. The examination is then conducted using the objective hearing test methods mentioned above. The test result is documented in the yellow examination booklet and, if the facility collaborates with a hearing screening center, transmitted to that center.

Children who show an abnormal result in the first stage of hearing screening (primary screening) initially undergo a repeat test (TEOAE, AABR) at the same facility as the second stage of hearing screening, continuing until the U2 checkup.

If the result is still abnormal at discharge, prompt further diagnostic testing is necessary. According to the law, this comprehensive diagnostic evaluation must be completed within the first three months of life.

Tracking by Hearing Screening Centers

Name-based tracking is organized by hearing screening centers, provided the birth facility is affiliated with a center. Tracking refers to the monitoring of children with abnormal test results or those who were not screened.

Data from all affiliated screening birth facilities and follow-up examination centers is transmitted daily to the tracking center. The transfer of personal data, measurement data, and data relevant to measurement quality occurs directly from the screening device.

If parents have provided the necessary consent, they are reminded multiple times via the hearing screening center about any pending follow-up examinations. Tracking thus helps ensure that all children receive a professional follow-up examination in a timely manner.

Unfortunately, hearing screening programs without tracking are characterized by a high “lost-to-follow-up” rate of up to 50 percent. This refers to children who, despite a screening result requiring follow-up in the newborn hearing screening, do not receive a proper follow-up examination.

Only with well-organized tracking can we ensure that children with hearing impairments are identified and treated early.

Follow-up Examination in Case of Abnormal Hearing Screening Results

If a test result indicates the need for further evaluation, parents will receive information about who to contact next and the next steps.

You can also obtain the addresses of qualified follow-up centers from all standard sources, such as your pediatrician or ENT specialist.

The follow-up to the hearing screening can be organized in two stages:

• Follow-up Stage 1: During a screening clinic visit, another hearing screening is performed using AABR measurement, and an otomicroscopy is conducted. If necessary, additional diagnostic measures are used (e.g., tympanometry to objectively assess middle ear function).
• Stage 2 Follow-up: If the abnormal hearing screening result is confirmed, a detailed pediatric audiological differential diagnosis is necessary in the second stage. Here, a definitive diagnosis is made regarding both the type and degree of any hearing loss. This establishes the crucial foundation for the next steps in treatment.

Continuous quality control and quality assurance

• of hearing screening programs as well as
• the “follow-up”

by the hearing screening centers. To this end, the hearing screening center conducts regular checks to ensure the completeness and quality of both the screening and the follow-up.

Key responsibilities of the hearing screening centers also include

• training and providing ongoing support to screening personnel,
• the selection of testing equipment and procedures, and
• the organizational procedures for confirmatory diagnostics at the follow-up facilities.

This is the only way to ensure that children with hearing loss present from birth are identified and referred for early therapy and habilitation.