Hearing impairment in infants is easy to ignore because it is invisible especially if the ears appear normal. Infants and toddlers cannot tell us they are unable to hear. Yet, hearing impairment is the one of the most common birth defect.

Babies learn to speak by listening and the child who does not have normal hearing will have delayed speech and language. The most critical years for the development of language are from birth to three years of age. Early identification of hearing impairment enables us to give the child the enriched input he needs to develop early listening, learning and spoken language skills.

Studies conducted worldwide have shown that early identification and the effective management of hearing loss significantly decreases irreversible and permanent impairments in speech, language and cognitive abilities. This holds true for babies who have a hearing loss with no additional difficulties that will compromise the development of speech. Early intervention, therefore, necessarily means early detection of hearing loss.

The Joint Committee on Infant Hearing, October 2007 and U.S. Public Health Service’s Healthy People 2010 health objectives recommend that all newborns be screened for hearing loss by 1 month of age, have diagnostic hearing testing to ascertain the degree and type of hearing loss by 3 months, and enroll in an appropriate intervention program by 6 months of age (Known as the 1-3-6 protocol).

I Hear Foundation started its Newborn Infant Hearing Screening Programme in December 2005. This was made possible by a very generous donation from the family of Mr. Pravin Jhaveri in his memory.

Why do we need Universal Hearing Screening?
Statistics show that while the reasons for some cases of deafness can be traced to high risk factors, 50% of children with a hearing loss have no known cause for their deafness. Universal hearing screening helps identify these children in time for us to intervene early, thereby preventing delay in language development. Abroad, this is a routine and standardized test done for every newborn soon after birth and/or prior to discharge from the hospital.

Without a hearing screen an infant with hearing loss is usually identified later in childhood, usually around 24-30 months of age. Infants absorb and learn a great amount of language during the first months of life even though they will not typically speak their first words until 12 months of age. Identifying hearing loss and providing early intervention improves a child’s language development.

Why should I have my baby’s hearing screened?
The most rapid development in speech-language, thinking, and social-emotional skills occurs during the first 3 years of your baby’s life. Good hearing is very critical for giving your baby optimal opportunities for facilitating this process of normal development. Undetected and/or untreated hearing loss, even if only mild, will lead to delays in overall development. Thus, this screening test is performed to rule out the possibility that your baby could have an undetected hearing loss. Early identification will allow you to give special help to your baby to learn these skills without any delay……for every baby deserves to grow up with sound.

Why should I have my baby’s hearing screened? I know my baby has normal hearing.
It is important to make sure your baby has normal hearing. The hearing screening test is sensitive and can catch even mild hearing losses that are very difficult for parents to observe in daily life. Babies with hearing loss react very similar to babies with hearing in different situations. Many parents of children identified with hearing loss did not realize the hearing problem until their children were 12-18 months old. These children missed out on early language development.

What if I choose not to have my baby’s hearing screened at this time, can I schedule it for later?
Yes, but the hearing screening must be done before 6 months of age. The aim is early identification, which produces the greatest advantage.

An undetected and untreated hearing impairment can present a great disadvantage for the child and can permanently damage speech and language. The sooner the impairment is identified the greater the opportunity the child has to develop normal speech and language.

Children with a hearing impairment can learn to communicate effectively if identified early.

Is the test painful to my baby?
No. The test is completely non-invasive. In fact, infants have to sleep during the test.

When should the test be done?
Ideally, it is best to get the test done soon after birth. The younger the baby, the more likely the baby will sleep during the test. As babies grow and become more aware of their environment, they are more alert and restless. Babies are required to be sound asleep during the entire test. If they do not sleep, then the parents have to wait for a long period of time, until their baby falls asleep.

Where is the test performed?
The test will be performed at our centre, with the baby sleeping in a nursery cot.

Who can be screened?
Neonates and infants between the ages of 37 weeks gestational age up to 6 months of age can be screened. The baby should not be on any CNS stimulants or be under any active treatment. The baby should not have cleft-lip, cleft-palate, microcephaly (small head) or macrocephaly, etc. The baby should also not have any oil in their ears or any earwax and should not have a respiratory tract infection.

Who will screen my baby?
Your baby will be screened by a trained and qualified Audiologist. The results will be reviewed by her and you will be notified of the outcome immediately after the test.

Link to who is an audiologist

How long does this hearing screening take?
It takes approximately between 30 seconds to 20 minutes to complete the test, if your baby is asleep. It depends entirely on how well your baby is resting. The screener will automatically stop testing if testing conditions are less than ideal.

What do I need to do when I bring my baby for the hearing screening?
Make sure there is no oil on your baby’s skin, especially around the head and neck region. Also please do not apply powder on your baby’s body. Please do not put oil in your child’s ears EVER. Feed or bathe your baby just prior to your appointment, so that your baby sleeps well…as this is required for the screening procedure. We would prefer if you put your baby to bed at the centre just prior to the test, as your baby needs to be asleep during the test. If your baby has slept en route to the centre for the hearing screening, then it is likely that your baby may not sleep when required. This would mean that you would need to wait for your baby to fall asleep again before we can begin the test. Please make your child wear suitable clothing so that we have easy access to his/her shoulders and nape of the neck.

How does the ALGO3i screen my baby’s hearing?
The screener uses a procedure called Automated Auditory Brainstem Response (AABR). Soft clicking sounds are presented to your baby’s ears through earphones. Each clicking sound produces a particular response from a special area of your baby’s brain. Sensors (that look like rectangular stickers) pick up these responses and send them to the ALGO 3i, which analyzes these responses. Your baby’s responses are compared with a pre-saved template or pattern of responses taken from thousands of other babies with normal hearing. At the end of the screening test, a ‘PASS’ or a ‘REFER’ result is generated. A ‘PASS’ result is generated if your baby’s responses match the pre-saved template. If your baby’s responses do not match the pre-saved template, a ‘REFER’ result is generated.

What does PASS/REFER mean?
The instrument will test each ear independently. A ‘PASS’ result indicates that the tested ear has normal hearing. A ‘REFER’ result only indicates that additional testing is needed. If your baby PASSES his/her screening, you can feel confident that he/she can hear even the softest sounds required for speech and language development. A REFER does not indicate any information about the hearing status in the test ear. It only means that further testing is recommended.

If my baby passes the hearing test, can s/he still develop a hearing loss later?
Some babies are born with risk factors that may cause a hearing problem later in infancy or even adulthood. Hearing loss can also be acquired due to illness, infection, or injury. If you think your baby is having difficulty hearing or developing speech and language skills, have your baby’s hearing tested by an audiologist skilled in paediatric evaluation.

What happens if my baby REFERS?
If the baby REFERS on either ear, the baby is re-screened after approximately three weeks. You will be referred to an ENT specialist for a check-up in the interim period.

Why do babies ‘REFER’ on the hearing screen?
Babies can fail the hearing screen for different reasons. Sometimes the problem noted is temporary (e.g. earwax or debris in the ear canal, oil in the ear canal while massaging, a cold/cough) and may resolve by itself. We would refer you to an ENT specialist as it is important that these issues are ruled out.

What happens if my baby REFERS again?
If a REFER is present on the second screen, a diagnostic and more detailed battery of tests is recommended to get adequate information about your baby’s hearing status. The diagnostic ABR test is one test that uses a different piece of equipment and is much more complex. The diagnostic ABR takes approximately one hour and sedation is required.

In addition to the ABR, other electrophysiological tests like the OAE (Oto-acoustic emissions) and Immittance testing may also be recommended. These tests will give more complete information about your baby’s hearing in each ear. Along with these tests that do not require your baby to actively participate (they are actually required to sleep); other behavioural tests will also be recommended. These behavioural tests require your baby to be awake and participate in the test. All instructions will be given to you for each of the tests to be completed, in the event that your baby requires a diagnostic hearing evaluation done.

Can I wait to have the detailed hearing tests done on my baby?
Early identification of hearing loss (before 6 months of age), even if it is mild, is the key to developing age appropriate speech-language and communication skills. It is important that your infant does not miss out on this opportunity for early language development. Babies begin learning language during the first months of life. A baby with hearing loss needs extra help in communicating and understanding language. If a baby needs extra help, you want to start as early as possible.

What are the chances of my baby having a hearing problem?
Hearing loss occurs in 3 out of 1,000 babies. The risk of hearing loss is higher for babies who spent time in intensive care nurseries compared to well baby nurseries.

It is important to test all babies because only 50% of babies identified with hearing loss have known risk factors such as some complication during pregnancy, difficulties at the time of birth, an illness, or a family history. The other 50% of babies who have a hearing loss may have no known high risk factors.

Please read the Speech and Hearing Checklist, so that you know how your baby’s language skills should develop.

You can have your baby screened for hearing at Naad, I Hear Foundation’s early intervention centre.

Please call 2388-8159 / 2388-7996 for an appointment. Our timings are from 09:00 a.m. to 1:00 p.m, Monday through Friday

Address:
Naad
C/o Dr. N.A. Shah,
Sanghrajka House, 2nd floor
Bhadkamkar Marg (Lamington Road)
Mumbai 400 004

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