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Hearing Testing

Newborn screening


Newborn hearing screening

Hearing screening for all newborns in the province was phased in beginning fall 2007.  Currently over 97% of babies born in BC are being screened.

  • Hearing screenings are quick and safe, and can be done right after birth.
  • Newborn hearing testing is important. Much can be done to help when hearing loss is found early.
  • About 1 in every 500 babies is born with permanent hearing loss. The number rises to 1 in 50 for babies is born in Special Care Nurseries - also known as Neonatal Intensive Care Units (NICUs).
  • Without screening, there are no obvious signs to tell early on if a baby has hearing loss. Over half of all babies identified with hearing loss are healthy and have no family history of hearing loss.
 

Soft sounds are played into your baby's ears while a computer measures the response from your baby. This shows how well your baby's ears respond to sounds. The screening tests are safe and will not hurt your baby.

The screening results will be given to you immediately after the test.
 

There are two types of screening tests. Your baby might have one or both tests: 


Automated Otoacoustic Emission (AOAE)

A soft earphone is placed into your baby's ear that plays quiet sounds. When the ear hears the sounds, the organ of hearing, known as the cochlea, makes a response that is detected by a sensitive microphone in the earphone. This response is called an otoacoustic emission. AOAE screening takes only a couple of minutes if your baby is quiet or sleeping.

Automated Auditory Brainstem Response (AABR)

Soft headphones sit over your baby's ears that play quiet sounds. Three small sensors are placed on your baby's head and neck. The skin is cleaned where the sensors will be placed so that they can make good contact with your baby's skin. The sensors measure the response of your baby's auditory (hearing) nerve to the soft sounds. AABR screening usually takes about 20 minutes if your baby is quiet or sleeping.

 

Most babies in BC have their hearing screened before they go home from the hospital. Some babies are discharged home from the hospital before hearing screening can be done, and other babies are not born in a hospital.


For babies who were not screened in the hospital, hearing screening is offered at your local audiology (hearing) clinic or community screening clinic. There is no cost for this hearing screening and you do not need a referral from your doctor. 


In most cases, your local screening clinic will contact you within the first few weeks to arrange a screening appointment for your baby. If you do not receive a phone call or your contact information changes, please call your local audiology clinic to find the hearing screening site closest to you.

 

Appointments 

Hearing screening is fastest for sleeping babies. Help get your baby ready for the appointment. Please try to have your baby fed and tired so he or she will fall asleep easily once testing is started.

If your baby is awake at the time of the hearing screening, we will need your help to keep your baby quiet. Sometimes the hearing screening can happen while you are feeding your baby. Please be prepared to feed your baby or provide a soother. You will be in a comfortable chair with your baby for the duration of the test.

You will find out your baby's screening results once testing is completed.

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Results

There are two possible screening results:

  • PASS – this means your baby is hearing well today
  • DID NOT PASS – this means a pass result was not obtained and further testing is needed

A pass result means that your baby is hearing well today. Hearing can change in some cases and children can develop hearing loss later in childhood. It is important to have your child's hearing checked if you ever have concerns about his or her hearing or speech and language development in the future.

 

If your baby did not pass hearing screening, it means that further hearing testing is needed but it does NOT mean that your baby has hearing loss. Approximately 2% of babies (700-800 babies per year in BC) do not pass hearing screening and are referred for a full hearing assessment with an audiologist. This is called an Auditory Brainstem Response (ABR) test.  


Of the babies who receive ABR testing in BC, approximately 1 in 7 will be identified with permanent hearing loss. Most of the babies referred for ABR testing are found to have normal hearing.
 

There are several reasons why a baby does not pass his or her hearing screening:

  • Hearing loss
  • Vernix in the ear canal
  • Fluid in the middle ear

It is VERY important to take your baby to his or her follow-up hearing testing appointments even though most babies will be found to have normal hearing. Sometimes not passing hearing screening is an indication of permanent hearing loss. Attending the follow-up appointments is the best way to be SURE about your baby's hearing.

 

If your baby has a risk factor for hearing loss, follow-up testing is recommended and the hearing screener will make a referral to your local public health audiology clinic.

Risk factors include:

  • Immediate family member with permanent childhood hearing loss
  • Congenital infection (e.g. CMV)
  • Cleft palate
  • Certain syndromes such as: Pendred, Branchio-Oto-Renal, Alport, Ushers, Neurofibromatosis, Down Syndrome
  • Certain serious early health issues
  • Very low birth weight (1,200 grams or less)

The best way to be sure about your baby's hearing is to attend all follow-up appointments. There may be other programs where your baby's hearing is routinely checked, such as the Neonatal Follow-Up Program or Cleft Palate Program. You may be called for appointments by one of these programs and by your public health audiologist on behalf of the BC Early Hearing Program. Please let clinics know if you are receiving services through another program. You might not need to attend both appointments if they are occurring around the same time.

 
Infant testing


Infant hearing testing

Your baby might require further hearing testing if he or she did not pass hearing screening or has certain risk factors for hearing loss.

Your baby will be referred to your local public health audiology clinic if further hearing testing is recommended. There is no cost for this appointment and you do not need a referral from your doctor.

The hearing testing done for your baby is called Auditory Brainstem Response (ABR) assessment and it is done while your baby is sleeping. It is important that ABR testing is completed before your baby is 3 months of age.

It is important to attend the recommended appointments to find out more about your baby's hearing. Over half of all infants identified with hearing loss are healthy and have no family history of hearing loss. Much can be done to help your baby’s language learning when hearing loss is identified early in life.

Auditory Brainstem Response (ABR) assessment

ABR assessment is an in-depth hearing test for your baby that is completed by a specially trained and certified pediatric audiologist.

All babies who do not pass hearing screening are referred for ABR assessment. ABR assessment takes longer than hearing screening because it identifies babies who have hearing loss and provides detailed information about your baby’s hearing levels. The ABR assessment is safe and does not hurt your baby.

ABR assessment can only happen while your baby is sleeping. It is important that you bring your baby to the appointment awake but ready to fall asleep in the clinic. 

It is important to keep your ABR assessment appointment to find out exactly how your baby hears. Sometimes it takes more than one appointment to accurately assess a baby’s hearing.

The ABR assessment is done while your baby sleeps. You will sit with your baby in a comfortable chair during the testing. The ABR assessment is scheduled for 2 to 3 hours, which includes time for you to feed your baby and help your baby fall asleep. Please be prepared to feed your baby in the clinic during the appointment.


Your baby is set-up for ABR assessment with two sensors on the forehead and one behind each ear. Sounds are played through earphones that fit inside your baby’s ears. The sensors detect how your baby’s ears and brainstem respond to sounds. 


In most cases the results of the ABR assessment will be explained to you immediately after the test.


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ABR assessment can only happen while your baby is sleeping. It is important that you bring your baby to the appointment awake but ready to fall asleep in the clinic. Try to keep your baby awake for at least 1 hour before the ABR assessment.

  • Try to delay feeding your baby for at least 1½ hours before the ABR assessment. You may feed your baby in the clinic during the appointment.
  • If you are driving to the appointment, have an extra adult in the car to play with your baby and keep him or her awake.
  • Bring any special blankets or items that may help your baby sleep.

There are no supervised play areas in the hearing clinic. If you need to bring other children with you, please bring another adult to look after them.

 

If your baby has a normal ABR assessment result and does not have any risk factors for hearing loss: No further testing is needed.


If your baby is found to have normal hearing and has one or more risk factors for hearing loss: The audiologist will refer your baby for follow-up hearing testing.


If your baby is identified with hearing loss: Regular hearing testing will be recommended for your baby.

 

Lots of parents ask why the ABR appointment does not happen right after the hearing screening. Although we understand that it can be difficult to wait, we recommend that babies are at least 4 weeks old for ABR assessment because:

  • Some early research has shown more accurate ABR assessment results when babies are at least 4 weeks old.
  • If your baby has fluid or debris in the ears from birth, waiting a few weeks gives the ears a chance to clear.
  • After 4-6 weeks you are more familiar with your baby’s feeding and sleeping patterns, we find that babies are more easily settled to sleep in the clinic which is important for the ABR assessment.
 

Yes, there is a chance that your baby has hearing loss. It is very important to follow-up with recommended appointments. Over half of all infants identified with hearing loss are healthy and have no family history of hearing loss.

 

Next steps if my baby is identified with hearing loss

Many families have told us that this can be a challenging time. You are still getting to know your baby and you have probably been given lots of information, which may seem overwhelming.

You are part of an excellent program that has been designed to support and help guide your family through these early stages. It is important for your baby that you stay involved.

Please see our section on Early Language Support for more information about the process you will be guided through.


Older children

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Toddlers & older children

It is important to get your child’s hearing checked at any time if you have concerns for your child’s hearing or speech and language development, even if your child previously had a normal hearing test. Hearing can sometimes change. Children can develop hearing loss later in childhood.

Call your local public health audiology clinic if you have questions about your child’s hearing or if you would like to make a referral.

There is no cost to have your child’s hearing tested and you do not need a referral from your doctor.

How is my child’s hearing tested?

The audiologist will use a combination of tests to measure your child’s responses to sounds and the function of your child’s ears.Each of the tests measures a different part of the auditory (hearing) system and adds information to the overall picture of your child's hearing.  See our Hear​ing Testing for Children brochure for more information.

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