Infant Hearing

Hearing loss is the most common birth defect in America according to the National Center on Hearing Assessment and Management (NCHAM). Everyday in the United States, approximately 33 babies are born profoundly deaf, and another 2 to 3 of every 1,000 babies are born with partial hearing loss each year (12,000 every year). Even more children lose their hearing later in childhood due to a variety of causes. 

According to the Centers for Disease Control and Prevention, hearing loss among newborns is 20 times more prevalent than phenylketonuria (PKU), a condition for which all newborns are screened, yet not every newborn's hearing is tested. Hearing loss present at birth usually goes undetected until delays in language development later become so acute that parents and pediatricians begin testing the child's ability to hear. The average age that a child with hearing loss is identified in the U.S. is 12 to 25 months of age, yet language acquisition actually begins at birth and progresses very rapidly during the first three years of life. 

Studies show that children with hearing loss who are diagnosed and receive appropriate early intervention services by six months of age are usually still able to develop good language and learning skills; but children who are deprived of critical language learning opportunities by an unidentified hearing loss experience related disruptions in social, emotional, cognitive, and academic growth.

About half of all hearing loss cases are thought to be caused by environmental factors (loud noises, bacterial or viral infections, or drug interaction), and the other half are due to genetic causes. Approximately half the children with hearing loss have no risk factors for it.

A baby's hearing may be affected by:

• Exposure to prolonged, high-decibel noise like that found near airport runways or at rock concerts
• Family history of hearing problems
• Serious problems during birth that may have deprived the baby of oxygen
• Premature birth
• Infections in the mother present at birth, including Group B streptococcus and Herpes Simplex Virus (HSV)
• Prenatal exposure to disease, such as rubella, syphilis, and toxoplasmosis
• Some types of birth defects, such as Waardenburg Syndrome
• Infections during infancy and childhood such as bacterial and viral meningitis, mumps, and chicken pox
• Chronic middle-ear inflammation (otitis media), which may cause scarring of the Eustachian tubes if your child has frequent ear infections.

 The American Academy of Pediatrics (AAP) recommends you have your baby's hearing checked shortly after birth, before he or she leaves the hospital. Most hospitals test newborn hearing as part of standard newborn screening; however, some only check babies who are considered high risk, such as those who have a family history of hearing loss or who had a difficult birth. According to the NCHAM data from 2004, the percentage of newborns whose hearing is screened varies between states from as low as 66 percent in California to 99.9 percent in Indiana. Most states have Early Hearing Detection and Intervention (EHDI) programs, which ensure that all newborns born in the state are screened for hearing loss and those who need help get it.  

• Auditory Brainstem Response (ABR): This test measures how the brain responds to sound. Clicks or tones are played through soft earphones into the baby's ears and three electrodes placed on the baby's head measure the brain's response.
• Otoacoustic Emissions (OAE): This test measures sound waves produced in the inner ear. A tiny probe is placed just inside the baby's ear canal which measures the response (echo) when clicks or tones are played into the baby's ears.

Both tests are painless, quick, and can be performed while your baby is sleeping or lying still. If your baby does not pass the hearing screening at birth, it doesn't necessarily mean he or she has hearing loss; most babies end up having normal hearing, but your baby should be tested further to rule out problems.

If your baby was not screened before leaving the hospital, call your baby's pediatrician and ask to have your baby screened. If you suspect your baby's hearing is affected, you can do a cursory hearing test at home:

• If your baby is younger than 3 months, clap your hands behind her head. If she startles, she can hear fine. If she doesn't, repeat several times.
• If your baby is between four and ten months old, call her name and see if she turns toward you or reacts to your voice.
• If your baby is between ten and 15 months old, she should be able to point to a familiar object when asked.

If your baby does have hearing loss, he or she should be seen by a hearing specialist (audiologist) experienced in testing babies and a pediatric ear/nose/throat doctor (otolaryngologist) for additional testing and diagnosis. Because children learn speech and language best when they are very young, it is important to begin intervention as soon as possible. If your baby is diagnosed with hearing loss, the EHDI program in your state will ensure you and your child are assigned a service coordinator who will help to establish an Individualized Family Service Plan (IFSP). This plan outlines all of the services, programs, and equipment that you and your child will need, and will change as your child grows and his or her needs change. The service coordinator will meet with your family at least every 6 months to review the IFSP and make necessary alterations depending on age and development.

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