Hearing tests for infants are a standard part of newborn care in most healthcare systems designed to identify potential hearing issues early. It’s normal to have questions about how these tests work, their safety, and what happens if your baby doesn’t pass. In this article, we’ll explore what infant hearing tests are, how they’re performed, their potential risks, and options if you’re considering alternatives.
What Are Infant Hearing Tests?
Infant hearing tests are quick, painless, and non-invasive screenings that assess how well a baby’s auditory system functions. These tests are important because hearing plays a key role in your baby’s ability to develop language, social, and cognitive skills and catching any potential hearing issues early is best because it allows for earlier intervention.
Infant Hearing Test As A Standard Of Care
Infant hearing tests are considered standard of care, and most U.S. states have enacted legislation requiring universal newborn hearing screenings. As of 2023, according to the National Center for Hearing Assessment and Management (NCHAM), 43 states have laws or regulations mandating these tests (1). The American Academy of Pediatrics (AAP) recommends that all newborns have their hearing screened before one month of age (2).
While legislation is in place, it’s important to note that hearing tests, like all medical procedures, still require parental consent. Parents have the right to decline these screenings if they choose, though early detection of hearing loss is strongly recommended to support language, social, and cognitive development. If you are unsure and opt out initially, testing can still be arranged at a later time through a pediatrician or audiologist.
To learn more about other procedures you’re likely to encounter during your baby’s first days of life, read these articles:
- Understanding Newborn Antibiotic Eye Ointment
- Newborn Screening: The Infant Heel Stick Test
- Why Infants Get Vitamin K1 At Birth
- Delayed Umbilical Cord Clamping: The Benefits & Risks
When Are Infant Hearing Tests Performed?
For hospital-born babies, hearing tests are usually done within the first 24–48 hours after birth, before discharge. If your baby is born at home or in a birthing center, a hearing test is often scheduled within the first month.
How Are Infant Hearing Tests Performed?
Two primary methods are used for newborn hearing tests: the otoacoustic emissions test and the auditory brainstem response test (3,4):
The Otoacoustic Emissions (OAE) Test
- How it works: A small probe is placed in the baby’s ear, emitting soft sounds and measuring the echo produced by the inner ear.
- What it checks: The function of the cochlea (inner ear).
- Duration: Just a few minutes.
The Auditory Brainstem Response (ABR) Test
- How it works: Small electrodes are placed on the baby’s head, and tiny earphones play soft sounds. The electrodes measure how the brain responds to these sounds.
- What it checks: The auditory nerve and brainstem pathways.
- Duration: Around 20 minutes, often while the baby is sleeping.
In most cases, the Otoacoustic Emissions (OAE) test is performed first as it is quicker, less complex, and effective for initial hearing screenings in newborns. If a baby does not pass the OAE test, a second screening with the OAE test is often conducted. If the results still indicate a potential issue, the Auditory Brainstem Response (ABR) test is typically performed to provide more detailed information about the auditory nerve and brainstem pathways.
How Accurate Are Infant Hearing Tests?
Hearing tests for infants are considered to be reliable in detecting infant hearing loss (5,6). However, false positives or other inaccuracies can occur. Temporary factors such as fluid in the baby’s ear, debris in the ear canal, or restlessness during the test may cause a baby to falsely present with hearing loss on the initial screening. For this reason, follow-up testing is essential to confirm results and rule out temporary issues (6).
Potential Types Of Hearing Loss In Infants
If follow-up testing confirms a hearing issue, understanding the type of hearing loss is important for determining the most effective treatment. As per the CDC, there are three primary types of hearing loss seen in newborns—conductive, sensorineural, and mixed (7)—each have unique causes, characteristics, and treatment approaches:
1. Conductive Hearing Loss
What it is: Conductive hearing loss occurs when sound is blocked from reaching the inner ear. This type of hearing loss affects the outer or middle ear and often results in muffled or reduced sound perception.
Common Causes:
- Fluid in the middle ear: Common after birth, especially in babies born via cesarean delivery.
- Ear infections (otitis media): Inflammation or infection can cause a buildup of fluid or pus in the middle ear.
- Structural abnormalities: Conditions like atresia (absence of the ear canal) or malformation of the ossicles (tiny bones in the middle ear) can impede sound transmission.
Potential Treatments Options:
- Drainage or antibiotics: If fluid or infection is present.
- Surgery: In cases of structural abnormalities or chronic infections, procedures like placing ear tubes or reconstructing the ear may be recommended.
- Hearing aids: Amplify sound if conductive loss is persistent or permanent.
2. Sensorineural Hearing Loss
What it is: Sensorineural hearing loss results from damage to the inner ear (cochlea) or auditory nerve. This type of hearing loss is permanent and cannot be reversed, but it can often be managed with assistive devices and therapies.
Common Causes:
- Genetic factors: Many cases of congenital hearing loss are linked to inherited conditions or genetic mutations. Some may occur as part of syndromes, while others happen independently.
- Infections during pregnancy: Viral infections such as cytomegalovirus (CMV), rubella, toxoplasmosis, or herpes can disrupt the development of the auditory system in the fetus.
- Birth complications: Prematurity, low birth weight, or oxygen deprivation during delivery (birth asphyxia) can lead to inner ear or auditory nerve damage.
- Exposure to ototoxic medications: Certain drugs, including aminoglycoside antibiotics or chemotherapy agents, can harm the delicate hair cells in the cochlea if administered to the mother during pregnancy or directly to the baby after birth.
Potential Treatment Options:
- Hearing Aids: Amplify sound for mild to moderate hearing loss, making speech and environmental sounds more audible.
- Cochlear Implants: Directly stimulate the auditory nerve, bypassing the damaged cochlea, for severe to profound hearing loss. Most effective when implanted early.
- Early Intervention Programs: Include speech therapy, auditory-verbal therapy, and sign language to develop communication and listening skills.
3. Mixed Hearing Loss
What it is: Mixed hearing loss is a combination of conductive and sensorineural hearing loss. For example, a baby may have damage to the inner ear (sensorineural loss) along with fluid in the middle ear (conductive loss).
Common Causes:
- A combination of factors affecting both the middle and inner ear, such as an ear infection with congenital sensorineural hearing loss.
- Medical conditions that impact multiple parts of the auditory system.
Potential Treatment Options:
- Combination approach: Treatments address both types of hearing loss. For instance, surgery or antibiotics might resolve conductive issues, while hearing aids or cochlear implants manage sensorineural loss.
Are There Risks With Infant Hearing Tests?
Infant hearing tests are widely regarded as being safe, but it’s natural for parents to want to fully understand any potential risks. Some common concerns from parents include questions about radiation, electromagnetic fields (EMFs), overstimulation, and skin sensitivity.
Radiation is not a factor in infant hearing tests. These tests rely on sound waves or electrical sensors, not imaging technology, so there is no exposure to radiation. To learn more about radiation from medical procedures, read this article: Radiation Detox for Kids: How to Support Your Child After X-Rays, CT Scans, or PET Scans
During infant hearing tests, such as the Auditory Brainstem Response (ABR) test, there is likely some level of electromagnetic field (EMF) exposure, though it is generally considered to be very low. Unfortunately, specific data on the exact level of EMF exposure during these tests is not readily available. Currently, there is no evidence that I could find to suggest that the EMF exposure from these tests poses any risk to infants.
Overstimulation is another common concern, as parents sometimes worry about exposing their baby’s sensitive ears to sound during testing. The sounds used are soft, brief, and carefully calibrated to avoid overwhelming a newborn’s auditory system. There is no evidence that these brief exposures cause harm or long-term effects.
Skin sensitivity may occur during the ABR test, where adhesive electrodes are placed on the baby’s scalp to record brain activity. While rare, some babies with sensitive skin might experience mild irritation from the adhesive, which typically resolves quickly without intervention.
Staying With Your Baby During A Hearing Test
Many parents worry that the infant hearing screenings will interfere with bonding time, especially in those precious early days or that the test will be stressful for their baby. The good news is that you can usually stay with your baby during the hearing test.
During the procedure, your baby may be swaddled, and it is not uncommon (and preferred by providers) for babies to remain asleep while the test is performed. Parents are usually welcome to remain close, and in most cases, you can even hold your baby or keep a reassuring hand on their body.
If you have concerns about separation or want to ensure your involvement, let your care team know. Most providers are happy to accommodate your preferences and include you in the process.
To learn more about the benefits of physical touch for your baby, read this article: The Benefits of Newborn Skin-to-Skin Contact
Are Hearing Tests Available For Babies Born Outside The Hospital?
Babies born at home or in birthing centers can still have their hearing screened. Families can arrange testing through a pediatrician or audiology clinic. These screenings should ideally take place within the first month to ensure timely diagnosis and treatment if needed.
Opting Out Of Or Delaying Hearing Testing
Parents have the final say on whether their baby undergoes a hearing test. If it doesn’t feel right at the moment, you can opt to wait and schedule the screening later. Likewise, even if your baby passes the initial test but you notice hearing concerns later, you can request a follow-up evaluation at any time.
Summary
Infant hearing tests are a standard part of newborn care, offering a safe, non-invasive way to assess your baby’s hearing. These screenings are routinely performed in hospitals, while for home-birthed babies, they are typically arranged within a few days to weeks after birth. The risks associated with these tests are minimal, but the benefits of early detection are significant, as they allow for timely interventions to support your child’s development.
References:
- NCHAM. (2023). State EHDI/ Newborn Hearing Screening Mandates Table. Infanthearing.org. http://infanthearing.org/legislative/summary/index.html
- Yoeli, J. K., & Nicklas, D. (2021). Hearing Screening in Pediatric Primary Care. Pediatrics in Review, 42(5), 275–277. https://doi.org/10.1542/pir.2020-000901
- Akinpelu, O. V., Peleva, E., Funnell, W. R. J., & Daniel, S. J. (2014). Otoacoustic emissions in newborn hearing screening: A systematic review of the effects of different protocols on test outcomes. International Journal of Pediatric Otorhinolaryngology, 78(5), 711–717. https://doi.org/10.1016/j.ijporl.2014.01.021
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Hearing loss and deafness in children: Learn More – Hearing tests in newborns. [Updated 2021 Apr 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK390297/
- Kosmidou P, Tzifas S, Lygeros S, Danielides G, Nikolopoulos T, Dimitriou G, Angelis S, Naxakis S. Newborn Hearing Screening: Analysing the Effectiveness of Early Detection of Neonatal Hearing Loss in a Hospital in Greece. Cureus. 2021 Nov 22;13(11):e19807. doi: 10.7759/cureus.19807. PMID: 34956791; PMCID: PMC8693701.
- NIDCD. (n.d.). Your Baby’s Hearing Screening and Next Steps. Www.nidcd.nih.gov. https://www.nidcd.nih.gov/health/your-babys-hearing-screening-and-next-steps#4
- CDC. (2024). Parent Guides to Hearing Loss: About the Types of Hearing Loss. https://www.cdc.gov/hearing-loss-children-guide/parents-guide-genetics/about-the-types-of-hearing-loss.html
