By Erin Holman, Au.D., CCC-A

A hearing loss can be identified, confirmed, and hearing aids can be fit within the first few weeks of life. This process depends on us, as professionals, to make appropriate and timely referrals as well as parents understanding the need for early intervention.

With the implementation of the universal newborn hearing screenings, we are able to identify hearing loss and provide appropriate intervention much earlier in life.

This reduces the effects hearing loss can have on a child’s speech, language and literacy skills. The critical language learning window is from birth to 3 years when brain neuroplasticity is the greatest. (Sharma et al., 2002) The listening experience during infancy is critical for the development of both speech and language in young children, and a strong spoken language base is essential for reading (Cole and Flexer, 2007).

Current guidelines for newborn hearing screening recommend:

  • Screening for hearing loss at birth or before 1 month of age
  • Audiological and medical evaluation before 3 months of age
  • Early intervention services, including appropriate amplification before 6 months of age

Numerous studies have outlined the benefits of early intervention for children with hearing loss. Yoshinaga-Itano (2003) reported that children identified and appropriately fit with amplification by 6 months have significantly higher language abilities than those identified after 6 months of age and they develop language at near normal rates. So, how do we test infants? A battery of objective tests is used to get an accurate picture of an infant’s hearing abilities. These include the following:

ABR (Auditory Brainstem Response)
Electrophysiological test of the auditory pathway used to verify the integrity of the auditory system and estimate hearing thresholds.

OAE (Otoacoustic Emission)
Verifies the health of the inner ear, specifically the outer hair cells of the cochlea, responses are present when hearing is better than 30 dB HL

Verifies middle ear function

Acoustic Reflexes
Tests the auditory pathway from the middle ear across the acoustic nerve.

As children get older we include behavioral subjective testing to our test battery.

The behavioral testing methods vary with age and include Visual Reinforced Audiometry (VRA), Conditioned Play Audiometry, and Traditional Audiometry.

Visual Reinforced Audiometry (6-30 months)
The child is conditioned to look at a toy when the stimulus is presented.

Conditioned Play Audiometry (2.5-5 yrs)
The child learns a game as a responses to sound, an example of the game includes placing a block in a bucket when the stimulus is presented.

Traditional Audiometry (5 yrs & up)
The child raises his hand or pushes a button when the stimulus is presented.

What can you do to provide your patients with the best opportunity for normal speech and language development and appropriate audiologic intervention?

All newborns should receive a newborn hearing screening. For those patients who have not been tested or received a referring result on the hearing screening, encourage parents to follow-up with an audiologist in a timely manner.

Children under 5 months of age can easily be tested in-office with an ABR or OAE while sleeping.

Once an infant reaches 6 months of age, this in-office testing becomes more difficult and the use of sedation may be needed to obtain a diagnostic hearing test.

Our recommendation is to have all infants’ hearing screened at 1 month of age and confirmation of hearing loss by 3 months of age.

There are many risk factors for hearing loss which require hearing evaluations as a child gets older. A few examples of these risk factors include:

  • Caregiver concern regarding hearing and speech or language
  • Family history of permanent hearing loss
  • NICU care of over 5 days
  • Ototoxic medications

A list of other risk factors can be found in the Joint Commission of Infant Hearing guidelines (2007).

As a parent or physician, we encourage you to call our office at 404-591-xxxx if you have questions about our services or if you have a child who needs a hearing evaluation.


Sharma A, Dorman M and Spahr A. A sensitive period for the development of the central auditory system in children with cochlear implants: Implications for age of implantation. Ear and Hearing Vol 23 (6), 532-539, 2002.

Cole, E., &Flexor, C. (2007). Children with Hearing Loss: Developing Listening and Talking, Birth to Six. San Diego: Plural Publishing.

Yoshinaga-Itano, C. (2003) Early Intervention After Universal Neonatal Hearing Screening: Impact on Outcomes. Mental retardation and Developmental Disabilities Research Reviews, 9, 252-266.

Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Pediatrics 2007;120;898-921 Joint Committee on Infant Hearing DOI: 10.1542/peds.2007-2333.