The Newborn Hearing Screening Programme is one of the most successful public health screening programmes in the UK. Before its introduction in 2005, most children with permanent hearing impairment were not identified until the age of two or three – a period during which spoken language acquisition is occurring and during which uncorrected hearing loss causes measurable, cumulative harm to language development. Now most children are identified within weeks of birth.
The test is quick, painless, and performed bedside while the baby is sleepy or asleep. It looks for a normal response from the inner ear and, in babies at higher risk, from the auditory brainstem pathway. A 'refer' result – meaning the response was not clearly detected – does not mean the baby is deaf. It means a more detailed assessment is needed.
Healthbooq (healthbooq.com) covers newborn screening and early child health.
How the Screening Works
The Newborn Hearing Screening Programme uses two technologies, depending on the baby's risk profile.
Automated Otoacoustic Emissions (AOAE): a small, soft probe is placed in the baby's outer ear canal. A series of soft sounds are played, and the probe measures whether the cochlea (the inner ear) produces tiny echoes in response – otoacoustic emissions. A healthy cochlea that is receiving sound normally produces these emissions. The test takes only a few minutes and requires the baby to be quiet or sleeping.
AOAE is the initial test for most babies. If it does not give a clear response (which can happen if the baby is unsettled, the ear canal contains fluid from birth, or there is background noise), a second attempt is made. If AOAE does not give a clear response after two attempts, the baby is offered the second test.
Automated Auditory Brainstem Response (AABR): small sensors are placed on the baby's head and electrodes detect the brain's electrical response to sound. This test checks the hearing pathway from the inner ear through to the brainstem. AABR is offered to all babies who do not pass AOAE, and to all babies who spent time in a neonatal intensive care unit (NICU) as a first test, because NICU babies have higher rates of auditory neuropathy (where the cochlea functions but the auditory nerve does not transmit signals normally – something AOAE would miss but AABR detects).
What Results Mean
A clear response ('clear' or 'pass') on both ears means the baby has passed the screening. It does not guarantee perfect hearing; late-onset, mild, or progressive hearing loss will not be detected at this point. Parents who notice concerns about their child's hearing at any age should discuss this with their GP or health visitor regardless of an initial pass result.
A 'refer' result in one or both ears means the screening did not detect a clear response. This is not a diagnosis of hearing loss. Many babies who are referred for further assessment are found to have normal hearing. Reasons for a refer result include a sleepy or unsettled baby during testing, fluid or vernix in the ear canal, or background noise. A referral leads to a full audiological assessment at a local hospital audiology department, ideally completed by 4 weeks of age.
What Happens at the Diagnostic Assessment
A full diagnostic audiological assessment uses ABR (auditory brainstem response testing), visual reinforcement audiometry (for older infants), tympanometry (to assess middle ear function), and OAE testing to build a detailed picture of hearing in each ear.
If permanent hearing impairment is confirmed, the family is referred to a multidisciplinary team including an audiologist, teacher of the deaf, speech and language therapist, and paediatrician. The goal is to have hearing aids fitted or a cochlear implant assessment initiated before the baby is 3 months old – the window in which early intervention has the greatest impact on spoken language development.
Permanent Childhood Hearing Impairment
Permanent hearing impairment affects approximately 1-2 per 1,000 newborns. About half of all permanent childhood hearing impairment is present at birth (congenital); the remainder develops or progresses during childhood. Causes include genetic variants (GJB2 gene mutations affecting connexin 26 are the most common cause of congenital hereditary hearing loss), congenital infection (cytomegalovirus), prematurity, and meningitis.
Cochlear implants are considered for children with severe to profound sensorineural hearing loss bilaterally who do not gain sufficient benefit from hearing aids. NHS England provides cochlear implantation for eligible children, with assessment through specialist implant centres.
Key Takeaways
The NHS Newborn Hearing Screening Programme (NHSP) screens all babies in England for permanent bilateral hearing impairment using automated otoacoustic emissions (AOAE) and automated auditory brainstem response (AABR) testing. The programme detects approximately 840 babies with permanent hearing impairment each year in England. Babies who do not pass the screening are referred for full audiological assessment; a screen result of 'refer' does not confirm hearing loss and most referred babies are found to have normal hearing at diagnostic assessment. Early identification of permanent hearing impairment (ideally before 3 months) allows hearing aids or cochlear implants to be fitted within a window that minimises the impact on speech and language development.
