Probes and Tips: An interactive newsletter promoting quality early childhood hearing screening practices

October, 2008 issue

Tip of the Month

Identify Appropriate Hearing Screening Methods for Each Age Group

Since Head Start programs must ensure that every child receives a hearing screening within 45 days of starting the program, it is important to identify the most appropriate screening method for each age group.

Newborns
Most newborns in the US now receive a physiological hearing screening before leaving the hospital. Newborn screening is done using otoacoustic emissions (OAE) or automated auditory brainstem response (ABR) technology.  For any child not passing the newborn hearing screening, it is critical that an audiological evaluation be completed as soon as possible.   For infants who pass the newborn screening, the newborn results can be used during the first year of life to satisfy  Head Start screening requirements. Because hearing loss can occur at any point in a child's life, however, it is preferable to screen again at the time the infant enters the Head Start program.

Infants and toddlers 0 - 3 years of age
The consensus among pediatric audiologists is that OAE screening is the most appropriate hearing screening method for this age group. OAE screening is performed by placing a small probe in a child’s ear canal that sends a quiet sound into the ear and simultaneously measures the ear’s physiological response. OAE screening is painless, does not require a behavioral response from the child, and can be even be done while the child is playing quietly or napping. The screening procedure can be performed by anyone who is trained to use the equipment and is good at working with children including program staff, health care professionals or volunteers. Children who do not pass the screening are referred to a pediatric audiologist for a full evaluation.

Children 3 - 5 years of age
Audiologists also agree that the most appropriate hearing screening method for this age group is typically pure-tone audiometry. In this procedure, a child is instructed to perform a behavior, such as raise a hand, upon hearing a sound delivered through headphones. A series of sounds are then presented which vary in loudness (decibels) and frequency (pitch) and the child’s responses are assessed. Audiometric screening can be performed by a trained health care professional or staff person. If children in this age group are unable to follow instructions because they do not speak the same language as the screener, are not mature enough to respond reliably to cues, or have disabilities that affect their ability to cooperate with audiometric screening, they can be screened reliably using the OAE method described above.

Updating Head Start Hearing Screening Practices Nationwide
Before OAE equipment became available, programs serving young children often had to rely on parent observations about their child's hearing as the primary hearing screening tool.  Unfortunately most parents cannot tell if their child has a hearing loss until speech delays become apparent.  Attempts were also made to screen young children using subjective methods such as bell ringing or hand clapping. These strategies were often frustrating and unsuccessful because young children are too easily distracted to respond reliably to auditory prompts. In addition, noisemakers do not  screen the range of sound frequencies critical for normal speech and language development.  Methods that require toddlers to gesture or point to pictures are also extremely difficult to implement and lack reliability with children 0 - 3.  While ear exams provide by health care providers offer valuable information about ear health, these exams usually do not include a hearing screening. 

Unfortunately, many Early Head Start staff and Advisory Committees across the U.S. continue to rely on outdated hearing screening methods.  As you have contact with other Grantees, ask about their hearing screening practices and share what you know. Also direct them to: http://infanthearing.org/earlychildhood/