Are you expecting or recently had a baby? Then you might have heard that your baby will need a hearing test when they are born.

If you deliver in a hospital setting (and perhaps in some birth centers), this will be offered during your stay. If you give birth at a hospital and are discharged quickly (midwives) or give birth at home with midwives then you will have to attend an appointment to have this done. I say “have to” but I mean, you can consent to do so as usual after being given all the necessary information to make that decision. Lets talk about risks (if any), benefits and how the screening works!

Disclaimer: this is not medical advice nor should it be interpreted as much. This blog is for informational purposes only. Please seek medical advice from your trusted healthcare professional.

Please note that I am speaking specifically about the program in Ontario, however I will provide information and links as appropriate for similar programs elsewhere in Canada and/or the United States. If you are from somewhere else and consume this blog regularly – please let me know and I will expand my sources and resources area to include your area!

What is hearing loss?

There are three types of hearing loss that occurs in newborns. Conductive, sensorineural and a mixed form (both).

Conductive hearing loss involves a problem with the outer or middle ear and can usually be corrected with either surgery or medications. The issue with the outer or middle ear causes problems with sound conduction to the inner ear for hearing – so it could be something like fluid in the ear or an eardrum perforation (a hole or tear).

Here is a pretty basic video on the outer, middle and inner ear for better understanding.

Sensorineural hearing loss is the opposite – in that the problem lies in the inner ear. This means that a hearing aid or cochlear implant may be needed. This type of hearing loss is associated with Cytomegalovirus infection (CMV) and genetic risk factors. It may also be associated with low oxygen during birth.

Have you ever seen those videos where baby hears for the first time? Those are often babies with cochlear implants! Cochlear implants are so cool in my opinion – this video made me cry. The smile. Learn more about them here.

Mixed hearing loss is – you guessed it – a combination of both. It could be sensorineural loss complicated by a conduction issue (ear wax, fluid, etc). It would worsen symptoms.

Sensorineural hearing loss is more common to see in an infant.

What might put my baby at risk for hearing loss?

As I mentioned above, there are certain risk factors associated with increased risk of hearing loss (particularly sensorineural hearing loss). Hearing loss could still be present without these risk factors (for example, conductive hearing loss), but if your baby does have any of these risk factors, it would be even more important to pursue the newborn screening.

• Syndromes associated with hearing loss (see examples here)
• Cytomegalovirus (CMV) infection – acquired during pregnancy, often associated with hearing loss later in baby’s life
• Other infections – herpes, syphilis, toxoplasmosis, rubella
• Genetic risk factors
• Family history of childhood hearing loss
• Low oxygen during birth + use of mechanical ventilation after birth
• Intensive care > 5 days (read more here about other associated risk factors)

See the CDC’s list here.

You, as the parent or caregiver, being concerned about your baby’s hearing is also considered a reason to test. So keep that in mind – perhaps you declined the testing immediately but are later concerned.. your child can still have a hearing assessment at any age!

Why is the hearing test important?

In Ontario, newborn screening is offered through the Infant Hearing Program. A hearing test is offered to all babies in the community – whether they are born in a hospital or at home (and yes, it is covered by the provincial plan here – for now).

Hearing loss can occur in childhood very early on as you can see from the above information – so this test offers an opportunity to ensure your child does not have any permanent hearing loss or hearing challenges. It can also help identify children who may be at risk for hearing loss. By screening and identifying those who are affected by hearing loss and those at risk, resource connections and referrals can be made to better support your child.

A screening hearing test will be done either in hospital or in a community clinic, if you decide to pursue it. It is a pass or refer situation – most babies do pass the test. If your baby does not, it could just mean they are at risk for hearing loss, and usually an appointment will be arranged for when they are a bit older to reassess. If the test identifies hearing loss or suspected loss, then you may also be referred directly for another test for baby that is more precise and in-depth.

When there is “no result”, meaning the test was incomplete for whatever reason, you will also be referred for this additional testing.

This newborn screening is not a complete hearing assessment – it’s just a screening tool to decide who might need a full hearing assessment or further follow up, essentially.

Here is a video with a great FAQ on the newborn hearing screening in the US and here is one from Alberta Health. Healthy Children also has a great FAQ page that explains two types of testing options.

Hearing tests are important because although there are signs of hearing loss we can look out for, sometimes it can be hard to identify based on outward signs alone. For example, a baby who has a degree of hearing loss may still hear loud noises but have difficulty as they grow with language development. That’s why it is preferable and advised to have the test done as soon as possible.

Are there risks to the test?

Hearing tests are considered safe. All sounds are safe for the ears and the probes they use are comfortable. The testing is done by audiologists who are trained in assessment and management of hearing and balance disorders. In Ontario they are licensed and regulated by the College of Audiologists and Speech Language Pathologists.

My Experience With Newborn Hearing Screening

I have had two babies (Maggie and James) tested in the community. As we delivered with midwives both times, we never did the hospital screening (with Maggie’s birth we were discharged within 3 hours after and James was born at home). We personally attended Erinoak which is an excellent facility that offers a lot more than hearing tests. You can find your regions test center listed here. I have seen the hearing tests done on unit and in outpatient at the hospital and the process is the same.

We had to book ours for when the kids were a few weeks old. I believe James had his around 6 weeks. I did not have any negative experiences either time. I felt that the audiologists were professional and the appointment is very quick. Maybe 5-10 minutes. Both kids passed.

What other signs can I look out for in regards to my baby or child’s hearing?

The best way to determine if your baby or child has hearing loss is to get a hearing assessment. Things that may hint at hearing issues in babies include:

• No reaction or startle with loud noises
• By ~6 months, does not turn towards a sound
• By ~1 year, does not say single word utterances like “mama”
• Does not turn head when name called
• Appears to hear only some sounds

In older children, you may notice speech delay or difficulty understanding speech (unclear). The child may not easily follow direction (this can often be overlooked!). They may also ask you to repeat things you say or say “huh?”.

If you notice these signs or have any concern about your child’s hearing, see your healthcare provider as soon as you can. And if you’re expecting or have a newborn – consider the benefits of a newborn hearing screening. Talk to your maternal care provider or paediatrician if you have questions.

Additional Resources

Ontario’s Infant Hearing Program

Hearing Screening Fact Sheet (Ontario)

Types of Hearing Loss

Cochlear Implants for Babies & Young Children

CDC Hearing Loss in Infants and Young Children

Alberta Health Early Hearing Detection FAQ

Studies

Risk factors associated with hearing loss in infants

Spontaneous perforation of the tympanic membrane in the first 10 days of life