Newborn hearing screening

Newborn hearing screening is the name given to a type of screening test that tests the hearing of newborn babies within the first weeks of life.

From March 2006, all babies in the UK are offered a hearing screen within a few days of birth.

The National Deaf Children's Society campaigned for screening to be introduced for many years, and now provides information for parents about screening and childhood deafness on behalf of the NHS in England, Wales and Scotland, and the Department of Health, Social Services and Public Safety (DHSSPS) in Northern Ireland.

The screen uses two quick and simple tests to see if there is a need for further investigation. These are called the Otoacoustic Emissions test (OAE) and the Automated Auditory Brainstem Response test (AABR). Both tests are painless for the baby.

The majority of areas will provide the screening test as part of maternity care in hospital. The test will generally be carried out by specially trained hearing screeners. Some areas will offer the screen in community clinics or at home. This will be done by health visitors or hearing screeners. 

The OAE test works on the principle that a healthy cochlea (inner ear) will produce a faint echo when stimulated with sound. A small ear-piece, containing a speaker and a microphone, is placed in the baby’s ear. A clicking sound is played and if the cochlea is functioning properly the ear-piece will pick up the echo. This is recorded on a computer that tells the screener if the baby needs to be referred for a further screening test. If the test records strong responses from the baby’s ear then they will not need any further tests.

The screening test is very quick and gives the result immediately. Being referred for further a screening test doesn’t necessarily mean that the baby has a hearing loss. It can be difficult to get a response if the baby was unsettled at the time of the test, if the room was noisy or if there is any fluid in the ear from the birth process. The test is usually repeated before referral for the second type of screening test.

The vast majority of babies will show strong responses to the OAE screening test. Around 15% will be referred for the AABR screening test.

The AABR screening test works by recording brain activity in response to sounds. Sound travels through the outer ear as vibrations. When it reaches the cochlea it is converted into an electrical signal. This travels along the nerve of hearing to the brain where it processed into recognizable sounds.

The AABR test does this by playing a series of clicking sounds through headphones that cover the baby’s ears. Three small sensors are placed on the baby’s head and connected to the computer equipment. If the hearing system is working normally then the computer will report strong responses. If there is no strong response then the computer will report that a referral should be made.

Around 3% of babies will go on to be referred for a full diagnostic assessent of the hearing.

Babies who do not show strong responses to the two screening tests will be referred on for a full diagnostic assessment of the hearing. This will be done at your local audiology department or sometimes offered at home. One to two babies in every 1000 born will have some level of hearing loss in one or both ears.

The diagnostic assessment will include tympanomenty and Auditory Brainstem Response (ABR) testing. For further information on what these tests involve you may like to read our booklet 'Understanding Deafness'. 

The major problem with late identification of deafness is the effect on language development. A delay in identification can mean a delay in establishing effective communication with the child. This in turn can have a long-term impact on their social and educational development.

Research undertaken in the USA has shown that a deaf child can develop language at the same rate as their hearing peers if:

• deafness is identified by the age of six months; and

• a good early intervention and support programme is provided.

Up until the advent of universal newborn hearing screening, many areas across the country provided targeted hearing screening for newborn babies. A number of high risk criteria were used to select babies that required hearing screening. They had the screening test soon after birth, usually before leaving hospital. The criteria included:

• a family history of deafness

• cranio-facial abnormalities

• exposure to drugs which damage the hearing system

• spending more than 48 hours in a Neonatal Intensiver Care Unit (NICU) or Special Baby Care Unit (SBCU)

However, 30% to 40% of deaf babies have no known risk factors and were therefore not tested. It is widely acknowledged by professionals working in the field that many deaf babies slipped through the net with the previous screening tests.

As 90% of deaf babies are born into families with no history of deafness, this early support is vital. The majority of parents have no experience of deafness. Early identification, followed by a good early intervention programme can make the process easier for the family and lead to better outcomes for the child. The early intervention can involve a range of professionals, including audiologists, teachers of the deaf, and speech and language therapists. It can also include contact with other parents and deaf adults. 

The Department of Health worked with the National Deaf Children’s Society to produce a series of leaflets for parents of newborn babies going through the screening process in England. These leaflets have also been adapted for Scotland and Northern Ireland. These leaflets have now been incorporated into the booklet given to pregnant mothers called 'Screening tests for you and your baby'. This information was written in consultation with parents and professionals. The screening information has two main aims:

• to provide parents with the information that they will need to make informed choices about the screening, and
• to provide clear and accessible information about each stage of the screening in order to minimise the anxiety felt by parents.

The leaflets for the newborn screening programme in England are available in  Bengali, Hindi, Gujarati, Punjabi, Urdu and British Sign Language (BSL). Click on the link for further information.

The information leaflets for the screening programme in Wales is also available in Welsh and can be downloaded from their website (see below).  

In each country of the UK the newborn hearing screening service is expected to meet a set of Quality Standards that records how many babies are tested, how many are referred to audiology for diagnostic testing and how many babies are identified as deaf following screening.

In England, a team of people carry out Quality Assurance visits to each screening service to assess the standard of service in screening, as well as audiology, education and social care services for deaf children under three years of age.

These visits are carried out every 18 months, or sooner if particular problems are highlighted. The Quality Assurance teams work is overseen by the Quality Assurance Board on which the NDCS has a seat.

The second round of Quality Assurance visits began in 2008 and summaries of each site visit report are available to download here.

Findings from the first round of Quality Assurance Peer Review Visits are available to download here.

The newborn hearing screening programmes in England and Wales also publish an annual report that can be downloaded from their websites (links below). 

For information on the newborn hearing screening programe in England go to the website here:

For information on the newborn hearing screening programe in Scotland go to the website here: 

For information on the newborn hearing screening programe in Wales go to the website here: