Eyes on newborn’s hearing

Telethon Speech and Hearing’s head of hearing services Philippa Hatch explains the benefits and limitations of newborn hearing screening. 


It is important to understand newborn hearing screening – how it works, what happens if a baby misses out on it in hospital, how it is different from tests in older children and its limitations. 

Telethon Speech and Hearing’s head of hearing services, Philippa Hatch

The hearing assessment for children from birth to 18 years differs greatly depending on the age of the child, their developmental capability, neurological development and the target condition being investigated. Testing models range from newborn hearing screening, visual reinforcement observation to play audiometry for children aged 0-10 years.

Newborn hearing screening differs from traditional hearing tests as it uses electrophysiological rather than traditional behavioral approaches to estimate hearing acuity. Whilst newborn hearing screening has been hugely impactful in terms of its capacity to lower the average age of diagnosis for sensorineural loss from an average age of three years to well below 12 months, it does have limitations. 

The test

Newborn screening is conducted in both public and private hospitals and is universally offered across WA. Testing is noninvasive and typically takes up to 15 minutes, with parents receiving a pass or a refer result. A pass result rules out all but a mild hearing loss. Abnormal results are termed ‘refer’. 

In WA, the test is performed via Automated Auditory Brainstem Response (AABR) and is an electrophysiological indicator rather than a behavioural indicator of hearing in infants.

Some children may fail the AABR due to fluid in the middle ear, neurological abnormalities and maturational issues. Following a refer (abnormal) result, infants are then offered a series of tests including a diagnostic auditory brainstem response test (ABR), tympanometry and otoacoustic emission testing to assess individual ear thresholds and site of lesion.   

Who is it for?

It is aimed at infants from 36 weeks gestation to about three months of age. Infants need to be asleep so testing can become more difficult as they age. Diagnosis is calculated from an algorithm of expected neurological results considering intensity and latency and is influenced by neurological integrity and maturation. 

Where infants meet certain high-risk criteria, such as having a congenital abnormality (ie atresia), they do not undergo screening and instead are referred directly for diagnostic testing. 

The limitations

Sensorineural hearing losses aside, some children also fail the AABR due to fluid in the middle ear, neurological abnormalities and maturational issues. A pass result at screening should not be considered a reflection of normal hearing nor a guarantee of normal speech and language development, especially as a mild loss may not be detected. 

This is particularly pertinent given that more than half of congenital sensorineural hearing losses worsen over time, hence a mild undetected loss may be diagnosed as a moderate hearing loss later in life. 

Regular monitoring of children’s hearing is recommended to rule out worsening sensorineural losses, acquired hearing loss and conductive hearing loss due to paediatric otitis media.

Key messages
  • The hearing assessment of children from birth to 18 years differs depending on age, developmental capability, neurological development and the target condition.
  • The standard test for infants from 36 weeks gestation to three months is a newborn hearing screening.
  • A pass result at screening should not be considered a guarantee of normal speech and language development. Regular monitoring is recommended.
  • Parental understanding of typical listening behaviours of infants is inconsistent and parental anxiety often influences requests for hearing assessments. 
  • If in doubt, an audiological assessment can rule out a range of ear health concerns and should include counselling around the typical development of listening and speaking in infants and young children.