Good hearing is vital for a child’s language development and social integration. This makes it all the more important to detect hearing problems as early as possible. Hearing screening offers precisely this opportunity, ideally immediately after birth. Find out why hearing screenings are so important, how they work, and what to do if the results are abnormal.
Key Takeaways
- What is a hearing screening?
- Why is a hearing screening so important?
- How does a hearing screening work?
- What happens if the results are abnormal?
- Which children are particularly in need of monitoring?
- What role does hearing screening play in language development?
What is a hearing screening?
A hearing screening is a specialised test carried out to detect hearing problems in newborns and young children at an early stage. The aim is to identify any potential hearing difficulties within the first few days of life so that treatment can be started in good time. This is because hearing problems detected early are easier to treat, and the chances of normal speech development are preserved.
Hearing screening is now part of the legally recommended early detection tests and is carried out as standard in many hospitals immediately after birth. It is not a diagnosis, but an initial check to see whether hearing is functioning normally.
Why is hearing screening so important?
In Germany, around 1,000 children are born with a congenital hearing impairment every year. Without systematic hearing screening, many of these hearing impairments initially go unnoticed, as babies react to many environmental stimuli even without intact hearing. Without targeted testing, important signs of hearing loss can therefore be overlooked.
However, an undiagnosed hearing impairment has significant consequences for the child’s language development, academic performance and social integration. Therefore, the earlier hearing loss is detected, the better the opportunities for targeted support measures.
How does a hearing screening work?
Hearing screening usually takes place immediately after birth in the maternity ward, typically between the 2nd and 4th day of life. It is carried out either by medical staff at the hospital or by specially trained staff at a screening centre.
The hearing screening is painless, takes only a few minutes and is ideally carried out whilst the newborn is asleep or lying still. There are two recognised methods for carrying it out:
Tinnitus-evoked otoacoustic emissions (TEOAE)
With this method, clicking sounds are transmitted into the child’s ear canal via a small earplug device. If the hair cells in the cochlea (inner ear) are healthy, they send back weak acoustic signals in response to these sound waves, known as otoacoustic emissions. These are recorded by the device.
Brainstem audiometry (BERA or AABR)
This method measures the brainstem’s responses to acoustic stimuli via small electrodes placed on the scalp. This method is more accurate than TEOAE testing and is primarily used in cases of abnormal initial findings or for children at risk, e.g. premature babies.
Neither method provides subjective assessments, but rather objective measurements. This means that hearing screening can be carried out reliably even in newborns.
What happens if the results are abnormal?
An abnormal result does not automatically mean that the child is hard of hearing. Sometimes the cause is simply blocked ear canals or residual fluid in the inner ear that has not yet completely cleared after birth. In these cases, a follow-up examination is advisable.
If abnormal results persist, further paediatric audiological diagnostics are recommended. This involves specialised tests such as extended brainstem audiometry or other measurement methods. The aim of this confirmatory diagnosis is to precisely determine the type and degree of the hearing impairment.
In this case, parents are entitled to a referral to a specialist paediatric audiology practice or to the relevant department at a university hospital. There, well-founded assessments regarding hearing function and possible treatments can be made.
Which children require particular monitoring?
Not all children face the same risk of a hearing impairment. There are a number of factors where particular attention is paid to hearing ability:
- Premature birth before the 33rd week of pregnancy
- Complicated birth involving oxygen deprivation
- Family history of hearing disorders
- Infections during pregnancy (e.g. rubella or CMV)
- Malformations of the head or face
- Stays in the intensive care unit after birth
In these cases, hearing screening is carried out particularly thoroughly, sometimes with immediate use of the BERA method, and follow-up appointments at paediatric audiology centres are arranged at an early stage.
What role does hearing screening play in language development?
A functioning sense of hearing is the foundation of all language development. Even in the first few months of life, children learn to recognise and imitate speech patterns and sounds from their surroundings. If this auditory feedback is missing due to an undiagnosed hearing impairment, the child cannot learn language as they normally would.
Studies show that children whose hearing loss was detected and treated before the age of six months have significantly better prospects for linguistic and cognitive development. If, on the other hand, hearing loss is only detected after the age of two, the developmental gap is often almost impossible to close.
Hearing screening is therefore a key component of early language detection and can help prevent problems later on.
Who carries out the hearing screening, and when?
In most cases, newborn hearing screening takes place at the maternity hospital immediately after delivery. Almost all hospitals across Germany participate in this programme. The test is usually carried out within the first 72 hours of life, but no later than the 10th day of life.
If the screening could not be carried out at the hospital - for example, because the child was born at home - the test can also be carried out at a private ENT specialist’s practice or at a hearing screening centre. Parents should be actively informed of this option.
How is hearing screening regulated by law?
Hearing screening has been part of the recommended U1/U2 early detection examination for several years. The costs of this examination are covered by statutory health insurance funds, regardless of the results.
Documentation is handled by a nationwide screening centre that cooperates with maternity hospitals. If no result is recorded or if a follow-up examination is necessary, this is also noted. The aim is to ensure that no affected infant ‘falls through the cracks’ but receives targeted further treatment.
What can parents do if abnormalities are detected?
If parents are informed that the hearing screening showed an abnormality, the first step is to remain calm. In many cases, the result is influenced by temporary factors.
It is important to attend the recommended follow-up examination and, if necessary, to be referred to a specialist paediatric audiology practice or phoniatrics department. There, a comprehensive hearing test will be carried out, during which the auditory nerve and the inner ear are also assessed in detail.
The child’s further development, particularly in terms of speech, reaction to sounds and interaction, should be closely monitored. If doubts persist, it may also be advisable to consult an ENT specialist again.
Hearing screening in adulthood: preventive care from middle age onwards
Hearing screening also plays an important role later in life. From the age of 50, the risk of hearing problems increases significantly, often gradually and initially unnoticed. Many people unconsciously adapt to the gradual hearing loss and only become aware of limitations when conversations in groups or in noisy environments become increasingly difficult. Early hearing screening can help to detect changes in hearing ability in good time and take timely action. The tests used are similar to those for children: they include a simple hearing test, tone or speech audiometry and, if necessary, further measurements of the inner ear or auditory pathway, such as brainstem audiometry.
Regular screenings from middle age onwards can not only detect hearing loss at an early stage, but also prevent secondary conditions. Studies show that untreated hearing loss can be associated with an increased risk of social isolation, depression and even cognitive impairments such as dementia. This makes it all the more important to include hearing in general health checks, ideally with an ENT specialist or as part of an occupational health check-up. Some health insurance providers cover such hearing tests as a voluntary benefit. Taking early action, for example by fitting modern hearing aids, not only preserves one’s ability to communicate but also one’s quality of life.