Testing Newborns for Hearing

 

 

 

Should All Newborns Be Tested for Hearing?    

 

The most common birth defect in the United States continues to go unrecognized, at least in a 

portion of the newborns affected. That defect is hearing loss. Profound hearing loss is present in two 

to three newborns out of every 1,000 births, and two to four newborns per 100 that require a stay in a 

neonatal intensive care unit. Moderate or unilateral hearing loss is even more common – it appears in 

four to 56 children per 1,000, depending on age.1 

 

Hearing is a function of the brain interpreting the frequency and intensity of air molecules as 

they enter the ear canal, impact the ear drum, activate the delicate bony ossicles in the middle ear, 

and transmit the resultant electrical messages to the brain. Intensity or loudness is measured in 

decibels.2 A whisper registers 30 decibels; a normal conversation 45 to 50 decibels. Discomfort 

appears at 90 decibels, and pain at about 120 decibels. If your world is silent to anything under 90 

decibels, you are considered deaf. If you cannot hear below 40 decibels, you are moderately 

impaired. Frequency or pitch is measured in hertz. Most normal sounds occur in the 250 to 6,000 

hertz range. Vowels occur in the 250 to 1,000 hertz range and are the easiest to hear. Consonants 

occur in the 1,500 to 6,000 hertz range and are more difficult to hear if one is hearing impaired. 

Consonants convey most of the meaning in language and speech. The inability to hear and interpret 

high-frequency sound therefore leads to developmental delays in speech and language.2 Even 

children with mild hearing loss miss 25 to 50 percent of speech in the classroom.3 After 25 decibels of 

loss, every additional 10 decibels of loss is associated with an educational delay of one year.4 

 

Early diagnosis and treatment of hearing loss can prevent long-term language, speech and 

learning problems.5 The average deaf student graduating from high school in the 1980s scored at the 

fourth-grade level for language and academic achievement.6 This reflects the fact that there is a 

concrete window of opportunity for intervention that occurs early in life. If missed, later catch-up may 

be impossible. In addition, the facts from the 1980s remind us that a great deal of progress has been 

made technologically in the past two decades. Assistive hearing devices are far more advanced, and 

cochlear implant procedures are now performed in more than 250 hospitals across the country. 

Approximately 25,000 people in the United States have them. In the right child, cochlear implants 

decrease the need for special education and double the likelihood of successful mainstream 

education.3 In general, appropriate treatment should begin by 6 months of age to achieve maximum 

benefit.6 

 

Effective screening tests now exist to cost-effectively detect congenital hearing loss. With good 

equipment and training, false positives are uncommon and are usually the result of transient middle- 

ear fluid dampening sound.1 The least invasive test, the Otoacoustic Emission Test, or OAE, 

measures the echo from sound waves transmitted through a small sponge transmitter placed in the 

ear canal. Another commonly used test, Auditory Brainstem Response, or ABR, measures brain 

electrical activity through scalp electrodes in response to sound transmitted through earphones.7 

Two-stage screening, with failure in the first test leading to follow-up with the second test, when done 

 

by trained, competent personnel, yields less than 3 percent of patients who need further follow-up, 

and less than 1 percent requiring full diagnostic work-up.1 

 

In the past, the battle lines have been drawn between those favoring universal testing for 

newborns and those supporting testing only in high-risk newborns including premature infants and 

those with mental retardation, cerebral palsy, epilepsy, and vision impairment. Yet studies clearly 

show that only 50 percent of those suffering profound hearing loss are in this high-risk category.3 This 

is part of the reason that, over the years, the Joint Committee on Infant Hearing, the American 

Academy of Pediatrics, the National Institutes of Health, the American Academy of Audiology, the 

U.S. Preventive Services Task Force, and others have endorsed universal hearing testing of all 

newborns before 1 month of age, diagnostic follow-up by 3 months, and intervention, when indicated, 

by 6 months.5 

 

When we miss newborn hearing loss, it results in significant social, economic and health costs 

to society. If treatment isn’t begun early, a deaf special ed student requires $420,000 of public 

support by high school graduation, and more than $1 million throughout his or her lifetime.8 In 2003, 

there were 72,000 such students.2 Beyond economics, there is the lost human potential and the 

impact on the families. As hearing expert Dr. Abbey Berg from Columbia University notes, “Consider 

also the feelings of guilt, anxiety, and anger experienced by parents of children who were not 

diagnosed until later in childhood when signs of significant speech and language delay were 

evident.”1 

 

Currently, 44 states, plus the District of Columbia, have Early Hearing Detection and 

Intervention laws or voluntary compliance programs that screen the hearing of more than 95 percent 

of newborns – 39 states have laws and five states have voluntary programs. 9 But we still have some 

ground to cover.  In 2004, approximately 69 percent of babies in the United States were tested .3 That 

leaves approximately one-third slipping under the radar screen. In addition, detection is still a long 

way from treatment. In one study, 44 percent of those with positive screening tests did not receive a 

diagnostic work-up by 3 months, and more than 40 percent were not afforded treatment by 6 

months.3 And that is not the result of weak parental support. Eighty-five percent of parents believe the 

benefits of universal testing outweigh the risks, and 73 percent are willing to pay $30 out of their own 

pocket for the tests. Less than half of 1 percent refuse to have the test.1 

 

Kids deserve a chance for a full life. Universal newborn hearing screening and proper follow-up 

gives them just that. 

 

For Health Politics, I’m Mike Magee. 

 

 

References 

 

1. World Health Organization. World Health Report 1999: Making a Difference. Geneva, 1999. 

2. World Health Organization. Mental and neurological disorders. Fact sheet No. 265. December, 

2001. 

3. Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, et al. Cross-national 

epidemiology of major depression and bipolar disorder. JAMA. 1996;276:293-299. 

4. Glass RM. Awareness about depression: important for all physicians. JAMA. 2003;289:3169- 

3170. 

5. Institute of Medicine. Reducing Suicide: A National Imperative. Washington DC, 2001. 

6. National Institute of Mental Health. Real Men. Real Depression. March, 2003. 

7. Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms. Available at: 

http://www.mayoclinic.com/invoke.cfm?objectid=8022027A-C9BC-4931-B93F392D2BC06876. 

Accessed Aug. 25, 2005. 

8. The Cleveland Clinic Health Information Center Web site. Depression in Men. Available at: 

www.clevelandclinic.org/health/health-info/docs/2200/2286.asp?index=9307. Accessed Aug. 

25, 2005. 

9. Wartik N. Depression Comes Out of Hiding. The New York Times. June 25, 2000. 

10. Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time 

among US workers with depression. JAMA. 2003;289:3135-3144.