Newborn Hearing Screening
Alabama's Listening! is the Early Hearing Detection and Intervention Program (EHDI) for the Alabama Department of Public Health. The program was initiated in February 2001 to ensure all Alabama birthing facilities were able to screen for newborn hearing loss, which is the most commonly occurring birth disorder in the United States.
In 2008, Universal Newborn Hearing Screening (UNHS) became a mandated part of the Alabama Newborn Screening panel of disorders. The goal of the program is to create and maintain UNHS programs in Alabama to ensure early identification, treatment, and intervention of infants with hearing loss.
Any child who has been identified with hearing loss should be referred for early intervention services as early as possible. To utilize Alabama's Early Intervention System, fax a completed referral form to (334) 293-7393.
Hearing screening is performed at 24-48 hours of age, or before the baby leaves the hospital. Parents and health care providers can learn more about the process from our Newborn Hearing Screening flyer.
Alabama Early Hearing Detection & Intervention (EHDI) Workshop
The Alabama Department of Public Health Newborn Screening Program hosted the first EHDI Workshop on Friday, April 27, 2018, at the Alabama School for the Deaf and Blind (AIDB) in Talladega, Alabama. Thank you to all the presenters and participants for making the program a success. Thank you to AIDB for all of their assistance in planning the event and for use of their fabulous facilities.
Presentations included the following:
- Alabama EHDI Program Overview
- Hearing Equipment Demonstration
- Children's Rehabilitation Service Program Overview
- Early Intervention System Overview
- Procedures for Uploading Hearing Results
- Universal Newborn Hearing Screening
Congenital Cytomeglovirus (CMV) and Hearing Loss
Congenital CMV is the most common non-genetic cause of childhood sensorineural hearing loss. According to the CDC, about one out of every 150 babies are born with congenital CMV infection. However, only about one in five babies with congenital CMV infection will be sick from the virus or will have long-term health problems such as hearing loss.
Some babies without signs of congenital CMV infection at birth may have hearing loss. Hearing loss may be present at birth or may develop later in babies who passed their newborn hearing test. Congenital CMV infection can be diagnosed by testing a newborn baby's saliva, urine, or blood. Such specimens must be collected for testing within two to three weeks after the baby is born in order to confirm a diagnosis of congential CMV infection. For more information visit the CDC webpage.
Early Hearing Detection & Intervention Pediatric Audiology Links to Services (EHDI-PALS) is a new easy-to-use online directory that helps families find the nearest clinic providing the type of hearing service their child needs. Visit EHDI-PALS for more information.
Parent Resource: Online American Sign Language Class
Parents who have a deaf or hard of hearing child age 36 months or younger have the opportunity to learn American Sign Language (ASL) online at no cost. To participate in Sign It! parents must apply through the National Center for Hearing Assessment and Management (NCHAM).
Reporting Requirements for Hearing Screening
Each year, the Centers for Disease Control and Prevention's (CDC) Early Hearing Detection and Intervention Program (EHDI) conducts the Hearing Screening and Follow-up Survey (HSFS). This survey is designed to collect national data on the number of infants screened, diagnosed, and referred to early intervention for hearing loss, in an effort to monitor the state's efforts in meeting the national EHDI goals. For a comprehensive view of the data provided to the CDC and to see how Alabama compares to other states, you can access the Hearing Screening and Follow-up Survey at the CDC website.
Newborn Hearing Screening Resources
- ALGO 5: Screening, Uploading, and Maintenance
- Audiological Provider Form
- CDC Early Hearing Detection and Intervention Resources
- CMV Ends With Me Video Campaign
- CRS Hearing Clinics
- Early Hearing Detection and Intervention Checklist for Pediatric Medical Providers
- Joint Committee on Infant Hearing (JCIH) Position Statement
- JCIH 2007 Position Statement: Principles and Guidelines for Early Intervention After Confirmation of Hearing Loss
- National Center for Hearing Assessment and Management (NCHAM) "It's Natural" Video
- NCHAM Newborn Hearing Screening Training Curriculum
- Newborn Hearing Screening Hospital Algorithm
- Open Provider Letter
- Program Guidelines
- Universal Newborn Hearing Guidelines for Medical Providers
Developmental Milestones in Hearing
Parents can use this as a guide to see how their child is progressing developmentally.
Birth to three months:
- Jumps or blinks to loud sounds
- Wakes up to loud sounds
- Quiets when he or she hears mom's voice
Three months to six months:
- Turns eyes or head to search for the sound source
- Responds to your voice even when you cannot be seen
- Enjoys toys that make sounds
- Starts babbling
At six months:
- Responds to his or her name
- Turns head to the direction of the sound source
- Begins to imitate speech sounds
At 10 to 12 months:
- Understands and follows simple directions
- Gives a block or toy to you when asked for it without pointing
- Imitates speech sounds of others
At 13 to 18 months:
- Follows simple one step directions
- Uses 3-20 single words
- Points to 1-3 body parts when asked
At 19 to 24 months:
- Understands approximately 300 words
- Puts two words together ("eat cookie") by 24 months of age
- Points to five body parts
- Responds to "yes" or "no" questions
Every Baby Should Have a Hearing Screening
Statistics show that between 1 to 6 newborns per 1,000 have some degree of hearing loss. Although these statistics indicate that it is unlikely that most babies will have a hearing loss, it is important to identify existing loss as soon as possible since the first two years of a baby's life are critical for learning speech and language. Because any hearing loss could affect a baby's speech and language development, diagnosis and appropriate intervention should occur by 6 months of age or earlier.
Hearing Screening Methods
There are two types of hearing screens that may be used to test for hearing loss. Both tests are very safe, take only minutes to perform, and are non-invasive. Most infants sleep though the hearing screening procedure.
- Automated Auditory Brainstem Response (AABR): A soft click is presented to each ear through miniature earphones while electrodes placed on the infant’s forehead, neck, and shoulder record the response as it travels between the ear and brain. The response is analyzed to determine how well the inner ear and auditory nerve are working. This test method is recommended for high-risk newborns admitted to the NICU greater than five days and should be completed as a second test method if an infant is initially tested with AABR.
- Otoacoustic Emissions (OAE): Soft clicks or tones are presented into the infant’s ear through a probe snugly placed in the entrance to the ear canal. A small microphone in the probe measures the echo that returns from the infant’s ear. The OAE equipment analyzes this echo and determines how well the inner ear is working.
Hearing Screening Results
If an infant does not pass the first hearing screen, an attempt may be made to repeat the screen before hospital discharge, or it may be scheduled after going home. If an infant does not pass the second hearing screen, additional hearing tests should be administered under the care of an audiologist or otolaryngologist.
Although only a small percentage of infants who do not pass the hospital hearing screen actually have hearing loss, it is important for every baby to receive appropriate testing to adequately determine hearing ability. Also, because early intervention is so important to the development of infants with hearing loss, it is important that the testing not be delayed. It is recommended that all testing be completed by three months of age and that infants with hearing loss be enrolled in an intervention program as early as possible, but no later than six months of age. An audiologist and/or physician can provide information on local early intervention programs, or the information can be obtained by calling 1-800-CHILD-FIND (1-800-543-3098).
Retesting May Be Needed
The results of the a hearing test indicate an infant's hearing ability at the time of the test. Some children with recurrent ear infections, serious acute or chronic illness, or with a family history of hearing impairment may develop hearing loss later in life. If there are ever any concerns about a child's hearing ability, or speech and language development, this should be addressed by the parents and the physician in order for an appropriate evaluation is to be completed.
Page last updated: March 19, 2019