Contents

1. Introduction
2. Hearing aids
3. Talking with your baby
4. Who does what?
5. Hearing screening for babies
6. What's in a word
7. Sources of information

5. Hearing screening for babies

The Newborn Hearing Screening Programme

The Newborn Hearing Screening Programme (often referred to as NHSP or occasionally as NHS to really confuse you) is gradually being phased in across England and Wales. This programme sets out to screen all babies for hearing loss within days of their birth. Most areas are using a hospital based screening programme, while Mum and baby are still in the maternity ward. Some areas are using a community based programme with health visitors being trained to screen babies at home.

How are babies being screened?

As the babies are so young behavioural techniques, which depend upon the baby responding to a sound stimulus, would not be reliable, although we know that babies this young do make responses to sound and do listen e.g. recognising Mum's voice very early.

Objective tests are the first line of testing. These are usually Otoacoustic Emissions (OAE's). OAE's measure the emissions (output) produced by the outer hair cells of the cochlear in response to a signal to the ear. It is a painless, screening test done while the baby is asleep and only tells you if the baby does or does not respond as would be expected.

But establishing that there flay be cause for concern about the baby's hearing is only the first step. Further testing will be needed to discover if there is definitely a hearing loss and how significant and permanent it might or might not be. We need to establish the degree and type of hearing loss and this means you may have to take your baby for a number of tests, as we describe below. One test alone will not give you enough information. While this is happening you can make a vital contribution with your observations of how your baby responds in the real world as well as in a clinic.

So, if the response to the OAE isn't quite as expected, the baby will be referred on for medical assessment, to check if there is fluid in the middle ear, for example, which happens quite often and can be quite easily dealt with. Tympanometry is usually used for this when a small probe is put into the ear and a tiny amount of air is puffed into the ear. The tympanogram measures the effect on the ear drum. This is quick and totally painless and gives an idea of how the eardrum and the middle ear are functioning.

Guidelines in the Newborn Hearing Screening Programme (NHSP) suggest a Diagnostic Auditory Brainstem Responses or ABR test for those infants who did not respond as expected to the initial OAF. ABR measures if and when the infant begins to respond to a (usually) click stimulus. This gives some indication of the degree of hearing loss. In fact it gives limited information because 'Click ABR' only gives information on the baby's response to frequencies around 2 - 4KHz. (See Section 4 for frequencies) It does not tell you about the baby's responses to mid and low frequencies and a no response to the click- ABR does not necessarily mean 'no hearing'. Another test, a frequency-specific ABR or tone pip ABR can be used to examine lower frequency hearing.

The Newborn Hearing Screening Programme is a welcome development in audiology and the education of the deaf. It should lead to hearing loss being diagnosed at a younger age than previously. This gives parents and professionals the option to fit amplification at an earlier age and at an earlier stage in the infant's language development. in turn this brings greater opportunities for more age-appropriate language and social development for these children.

Other Tests

From around 6 months other behavioural tests can be used. One test used is the Distraction Test commonly used by health visitors. The baby sits on the parent's knee and is facing one tester while a second tester uses specific sounds behind and to one side to see if the baby will turn to them.

Visual Reinforcement Audiometry (VRA) is often used with young babies. This makes use of a conditioned head turn response where the baby will turn to a visual reinforcer, e.g. toy being lit up, when she hears a sound. She does not have to locate the sound source, turning to the same visual reinforcement every time. The sound may he presented to the child through speakers or through insert earphones i.e. tiny probes being put into the baby's ear and therefore giving more accurate measures of what the sound does ill the baby's ear.

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