Newborn hearing screening

Hearing loss refers to the loss of the ability to hear. About 4 to 6 of every 1000 newborns are born with some degree of hearing loss in one or both ears. For 1 in every 1000 newborns, hearing loss may have very significant consequences on their development.

Hearing loss may be related to a malformation or dysfunction of the outer ear, middle ear or inner ear. It can affect the ability to hear certain sounds (low or high) or all sounds. Some types of hearing loss are temporary and can be treated medically, while other types are permanent.

The Québec Newborn Hearing Screening Program aims to detect, as early as possible, hearing loss that is present at birth and which could adversely affect the child. Good hearing is essential for children to learn to speak and develop to the best of their ability.

The tests are painless and safe for the baby. They only take a few minutes and the results are available as soon as the test is over. This way, the necessary interventions (hearing aids, strategies for communicating with the child, etc.) can be initiated quickly to promote the child’s optimal development.

Although the tests are reliable, there are some limitations and disadvantages to participating in the program. There is a possibility that

• the tests will have to be done more than once;
• you will have to go to an appointment at the birth centre during the first month of your baby’s life;
• your child will not pass the screening tests, even if they can hear well;
• more in‑depth tests or examinations will have to be done in one of the program’s diagnostic confirmation centres;
• your child’s hearing loss will not be detected by the tests;
• your child will develop hearing loss in the first years of life, even if they passed the screening test at birth.

Hearing screening is offered free of charge to all newborns in Québec.

Babies born outside Québec and who are insured by the Régie de l’assurance maladie du Québec (RAMQ) can also have screening tests free of charge. Their doctor must refer them to the birth centre near their home before they are 1 month old. After this, participation in the program is no longer possible and the baby must be referred to an audiology department.

Participation in the program is voluntary.

Information about the program is provided by the nurse or midwife before the child is born. Do not hesitate to ask questions before making your decision. It will be noted on a consent form, irrespective of whether or not you agree to participate in the hearing screening program.

You do not have to do anything to ensure your newborn’s participation after signing the consent form. A baby who is born in hospital is screened before they return home. A baby who is born in a birthing centre or at home is screened during their first month of life, at the hospital centre near the family’s home.

The Québec Newborn Hearing Screening Program uses two types of screening tests. The presence or absence of risk factors for hearing loss in the newborn will determine which tests will be done. The tests can be done one after the other as needed. Most newborns will only need to have one of the tests. The tests are usually done while they are asleep and only take a few minutes.

The most commonly used test is the otoacoustic emissions test. It involves inserting a small earphone in your baby’s ear. The device plays sounds and records the ear’s response, much like an echo.

If your child does not pass the otoacoustic emissions test, or if they have certain risk factors for hearing loss, the auditory brainstem response test will be used. A small earphone is inserted in your baby’s ear and three self-adhesive sensors are placed on their head. The device plays sounds and records the response using the sensors.

If your baby passes the screening test for both ears, it means they are unlikely to have any hearing loss. Some babies with risk factors, however, are more likely to develop hearing loss in the first months of life, even if they passed the screening test.

You must be vigilant and monitor your child’s development cues as they grow. If you have concerns, it is important to discuss them with the professional responsible for following your child’s development so that they can be referred to the appropriate resources. Here are some cues you can use to track your child’s communication development:

Some babies are more likely to have hearing loss at birth due to the presence of a risk factor for hearing loss, for example:

• a family history of hearing loss;
• a malformation of the head;
• an infection contracted during pregnancy.

In this case, hearing monitoring is recommended in a pediatric audiology department around the age of 8 or 10 months.

If you are in this situation, you must contact the pediatric audiology department to make an appointment. The person who did the screening test will give you a document indicating the contact information for the audiology department near your home as well as the age at which monitoring is recommended. If you have any concerns about your baby’s hearing before the scheduled date of the appointment, contact the audiology department.

Babies born in hospital who do not pass the screening test while in hospital will be seen for a new screening test on an outpatient basis, about 14 days later.

For babies born in a birthing centre or at home, screening is done on an outpatient basis at the hospital centre affiliated with the birthing centre. All babies who do not pass the outpatient screening test are referred for a hearing assessment in audiology.

If your baby does not pass the screening test for both ears, it does not mean they have hearing loss, but that they are at higher risk of hearing loss. In this case, it is important that to have their hearing assessed (diagnostic confirmation). This is the only way to know if they have hearing loss or not.

If your baby does not pass the screening test, you do not have to do anything. Your baby will immediately be referred to a diagnostic confirmation centre that specializes in assessing newborn hearing. An audiologist will contact you within a maximum of five days to arrange an appointment date. Do not hesitate to ask them any questions you may have. The appointment usually takes place within one month of screening.

The audiology assessment may indicate that hearing is normal, but if there is hearing loss, the audiologist will be able to identify which part of the ear is affected and the degree of hearing impairment. Several appointments may be needed to complete the hearing assessment. Usually, it is completed before the baby is three months old.

When hearing loss is detected, the audiologist refers the baby and their family to an ear, nose and throat specialist or ENT doctor. They will do examinations to determine, among other things, whether the hearing loss is permanent or temporary and to assess the possibility of treatment.

The ENT doctor may also recommend additional tests such as medical imaging or a genetic evaluation, for example.

Following the interventions of the audiologist and the ENT doctor, you will have the information you need to understand what hearing loss is, its probable consequences for your child and the possibilities for reducing the consequences. This may include, for example, using a hearing aid, a cochlear implant or communication strategies.

You will be given help so that you can make informed decisions for your child and family. Throughout the assessment process, do not hesitate to ask the audiologist or the ENT doctor any questions you have. Once the assessment has been completed, the audiologist will refer you to rehabilitation services so that your child can receive appropriate support for their needs.

Information about all the children who participate in the program is kept in a database. It is personal information that identifies the child and their parents (e.g., name, date and place of birth) as well as test results, assessments, recommendations and referrals.

The data is exchanged confidentially between the people in charge of screening and the institutions involved, for the purpose of

• doing new tests;
• offering the child the services they need;
• evaluating and ensuring the quality and continuous improvement of the program.

For babies whose parents have refused to participate in the program, only some information is kept for identification purposes. This information is destroyed after five years.