When should a child have a hearing test?
Every baby should have a hearing screening test by 1 month of age, a full diagnostic test by 3 months if the screening is not passed, and support (such as hearing aids) by 6 months if hearing loss is found. This is the international “1-3-6” standard of the US Joint Committee on Infant Hearing (JCIH), which now encourages an even faster “1-2-3 months” timeline where possible [1].
Older children should be tested whenever parents, teachers or doctors are worried — for example if a child does not respond to sounds, is late in starting to talk, speaks unclearly, turns the TV up loud, or often says “what?”.
How common is hearing loss in babies?
Permanent hearing loss is found in about 1 to 3 of every 1,000 babies. In the USA, screening programmes find about 1.7 per 1,000 babies screened [2], and the US National Institute on Deafness and Other Communication Disorders says about two or three of every 1,000 children are born with detectable hearing loss in one or both ears [3]. Indian studies report figures from about 1.3 per 1,000 up to 5–6 per 1,000, depending on the population studied [4]. Because it cannot be seen, hearing loss in a baby is easily missed without a test.
Which babies have a higher risk of hearing loss?
Babies have a higher risk of hearing loss if any of these apply, according to the JCIH 2019 risk indicators [5]:
- A family history of permanent hearing loss starting in childhood
- Neonatal intensive care (NICU) for more than 5 days
- Jaundice (hyperbilirubinaemia) that needed an exchange transfusion
- Cytomegalovirus (CMV) infection during pregnancy
- Bacterial meningitis or other serious infections
- Malformations of the face, ear or skull (craniofacial anomalies)
Babies with risk factors should be followed up even if they pass the newborn screening, because some hearing losses appear later.
What is an OAE test?
An OAE (otoacoustic emission) test is a quick, painless hearing screening that checks whether the inner ear (cochlea) responds normally to sound. A small soft probe is placed in the baby’s ear; it plays quiet clicks and measures the faint “echo” that healthy outer hair cells in the cochlea send back [6]. It takes a few minutes, needs no answers from the child, and is easiest while the baby is asleep or calm.
A “refer” result does not mean the baby is deaf. Fluid or debris in the ear after birth, movement or noise can cause it. It simply means the baby needs a repeat or a more detailed test.
What is a BERA (ABR) test?
A BERA test — brainstem evoked response audiometry, also called ABR (auditory brainstem response) — measures how the hearing nerve and brainstem respond to sound, using small sticky electrodes on the head while sounds are played through earphones [3]. The child must be asleep or lie very still, so tests are usually done during natural sleep; some children need a sedative prescribed by a doctor [7]. A diagnostic BERA can estimate how loud a sound needs to be for the child to hear it, ear by ear [7].
A short automatic version (AABR) is used for newborn screening.
What is the difference between OAE and BERA?
The difference between OAE and BERA is what they test: OAE checks the inner ear only, while BERA also checks the hearing nerve and brainstem. This matters because of a condition called auditory neuropathy, in which the inner ear works but signals do not travel properly along the nerve. A baby with auditory neuropathy can pass an OAE test but shows an absent or very abnormal ABR [6][8]. For this reason, babies who have been in neonatal intensive care should be screened with automated ABR rather than OAE alone [1][8].
| OAE | BERA / ABR | |
|---|---|---|
| What it checks | Inner ear (outer hair cells of the cochlea) | Inner ear, hearing nerve and brainstem |
| Time | A few minutes | Longer — a diagnostic test depends on how well the child sleeps |
| Child must be | Calm or asleep | Asleep or very still |
| Finds auditory neuropathy | No | Yes |
| Main use | Screening | Screening (AABR) and diagnosis |
What hearing tests are used for toddlers and young children?
Toddlers and young children are tested with games that turn listening into play. For babies from about 6 months to 2½ years, visual reinforcement audiometry (VRA) rewards the child for turning towards a sound with a lighted toy or screen [9]. From about 2 to 5 years, conditioned play audiometry teaches the child to drop a block or put a peg in a board each time they hear a beep [10]. Older children can do the same hearing test as adults. A tympanometry check of the middle ear is often added, because fluid behind the eardrum (“glue ear”) is a common, usually temporary, cause of hearing problems in young children.
Is newborn hearing screening available in India?
Yes. India’s national child health programme, Rashtriya Bal Swasthya Karyakram (RBSK), lists congenital deafness among the defects at birth it screens for, and hearing impairment among developmental delays [11]. Many government and private hospitals screen newborns before discharge. If your baby was not screened, or did not pass, arrange a test as soon as possible.
What happens if my child has hearing loss?
If your child has hearing loss, early support makes a big difference to speech and language. Depending on the type and degree of loss, this can include hearing aids fitted to the child’s ears, speech and language therapy, medical treatment for ear infections or glue ear, or — for severe to profound loss — a cochlear implant. Read cochlear implant or power hearing aid? and about our speech therapy for children.
Can Fairfield test my child’s hearing?
Yes. Fairfield Hearing Clinics tests children’s hearing at our New Friends Colony and Hari Nagar clinics, using methods suited to the child’s age, including OAE screening, middle-ear checks and play-based hearing tests. If your child needs a diagnostic BERA, we explain why, where it can be done and what to bring, and we help you understand the report. Book a hearing test for your child.
References
- Joint Committee on Infant Hearing. Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs — Executive Summary. https://www.jcih.org/JCIH_2019_Executive_Summary.pdf (full statement: J Early Hear Detect Interv 2019;4(2):1–44)
- Centers for Disease Control and Prevention (CDC). Data and statistics about hearing loss in children. https://www.cdc.gov/hearing-loss-children/data/
- National Institute on Deafness and Other Communication Disorders (NIDCD). Your baby’s hearing screening and next steps. https://www.nidcd.nih.gov/health/your-babys-hearing-screening-and-next-steps
- Jacob J, et al. Challenges of Universal Newborn Hearing Screening in a Developing Country. Indian J Otolaryngol Head Neck Surg 2022;74(Suppl 1):395–401. https://pmc.ncbi.nlm.nih.gov/articles/PMC9411324
- Joint Committee on Infant Hearing 2019 — Table of risk indicators (Minnesota Department of Health copy). https://www.health.mn.gov/people/childrenyouth/improveehdi/riskindicators.pdf
- NIDCD. Auditory neuropathy. https://www.nidcd.nih.gov/health/auditory-neuropathy
- Johns Hopkins Medicine. Auditory Brainstem Response (ABR) Evaluation. https://www.hopkinsmedicine.org/health/conditions-and-diseases/hearing-loss/auditory-brainstem-response-abr-evaluation
- American Speech-Language-Hearing Association. JCIH Year 2007 Position Statement. https://www.asha.org/policy/PS2007-00281/
- Texas Children’s Hospital. Types of hearing tests. https://www.texaschildrens.org/departments/audiology/types-hearing-tests
- Children’s Health (Dallas). Conditioned play audiometry. https://www.childrens.com/specialties-services/treatments/conditioned-play-audiometry
- Ministry of Health and Family Welfare, Government of India. Rashtriya Bal Swasthya Karyakram (RBSK). https://rbsk.mohfw.gov.in/RBSK/
