I am a pediatric surgeon. This is what I did when my newborn failed his hearing test

When my daughter failed her hearing test at the hospital the day after she was born, my mind was empty. As an ear, nose, and throat (ENT) surgeon, I regularly advise parents whose children fail the newborn ear exam. However, at that time, it felt like I had lost all the knowledge I had gained during my years of training.

As a doctor, I understand the consequences and statistics when parents take immediate action after failing to diagnose. But as a mother just 24 hours after I gave birth, I was very scared, and I was very upset, and I started thinking about the worst things.

This is a scary and uncertain moment, and those feelings are completely valid. But as I always tell the parents of my patients: This is just one point, not a diagnosis. It’s a starting point, and there’s a clear path forward.

This is what I did for my daughter and what I recommend other families do when their child fails a hearing test.

What does hearing loss testing mean?

A newborn hearing test is: a test, not a diagnosis.

It’s usually done within 24 to 48 hours of life using an otoacoustic emissions (OAE) test, which uses a small device to look at the cochlea, the snail-shaped organ inside the ear that’s critical to hearing, or an automated brainstem response (A-ABR) test. Although it is a great screening tool for early detection, it does not detect all types of hearing loss and can produce false positives.

Reasons why a child may not pass include:

• Debris in the ear canal (such as body fluids or tissue from childbirth)
• Vernix (new coating) in the ears
• Fluid in the middle ear (such as residual amniotic fluid)
• A noisy testing ground
• A small or moving child
• Technical problems with equipment or human error

Most of these are temporary and resolve on their own.

Most children who do not pass (or “pass,” as it is sometimes called) the first screening will continue to be tested later, but some will not. At this point, both should be considered seriously.

Having a plan can help reduce fear and uncertainty, so here’s what you can do.

Ask to be tested again

If a child fails or fails the first test, they usually have one more test before being discharged from the hospital. But it doesn’t hurt to explain to your care team that you want a repeat test before discharge.

Because I know how stressful this time can be, I created a list of resources that parents can use in real time:

• “Can we repeat the screening today?”
• “Can we try some new machines or probes?”
• “Would water or vernix affect the results?”
• “If it doesn’t kill us, can we do it again before we’re released?”

If your child does not pass the retest, he or she should be fully evaluated by a specialist.

Protect professional emails

Before I left the hospital with my daughter, I made sure I was referred to a pediatrician and an ENT.

These specialists can perform A-ABR, says Randi Tepper, Au.D., CCC-A, director of pediatric audiology and supervisor of cochlear implants at The Ear Institute, New York Eye and Ear Infirmary of Mount Sinai. The A-ABR test uses electrodes placed on the child’s scalp to record brain activity in response to sounds played through the ears.

After the dismissal, I made sure that the professional arrangements were made as soon as possible. My daughter was examined by all specialists within three weeks of her first medical examination.

I encourage parents to follow Early Hearing Detection and Intervention (EHDI) guidelines 1-3-6:

• Check-up is 1 month (usually done in the hospital within 24 to 48 hours)
• Medical examination is three months (with a specialist)
• Support after 6 months

Timeliness is the key to good results.

Create a maintenance team

If hearing loss is confirmed by diagnostic testing, care becomes a team effort. Families often work together with their pediatrician, pediatric ENT specialist, audiologist, and geneticist to first determine the cause of tinnitus.

This assessment may include:

• Imaging to assess the structure of the ear and cochlear nerve
• Genetic testing to identify inherited or underlying causes
• Testing for congenital cytomegalovirus (CMV), which is known to cause hearing loss and can be transmitted from mother to child during pregnancy.

If CMV is detected, additional specialists may be involved, such as an infectious disease doctor and an ophthalmologist (because CMV can also affect the eyes).

In some cases of genetic loss that is linked to genetics, other specialists may be needed for health-related issues. For example, you may also see a cardiologist for conditions such as Jervell and Lange-Nielsen syndrome, which cause hearing loss and heart failure.

From there, your care team works together to determine the best hearing aid option, which may include hearing aids, cochlear implants, or bone conduction devices.

Your team may also include an educational specialist, Tepper says. “A social worker can help guide families through the process and provide emotional support,” she says. “The teacher provides additional guidance and support and recommends early intervention strategies.”

Join the support team immediately

Early intervention should begin as soon as possible, preferably within six months. Hearing loss can affect a child’s speech, language, and social skills, but once they receive treatment, they can reach their full potential.

“The goal of early intervention is simple: help your child develop confident early communication skills and support critical situations,” says Tepper.

These services include things like speech and language disorders and medical and/or occupational therapy.

The more a child begins to use hearing aids or other means of communication, the more natural and effective the skill becomes.

Encourage your child

Parents are their child’s first and foremost advocate, and advocacy begins with awareness.

In addition to learning all you can about their child’s illness and treatment, parents should:

• Keep track of time, results, and time
• Ask questions if something is not clear
• Expect cooperation from your care team
• Look for support groups and resources

It’s also important to make sure your child wears any hearing aids or aids throughout the day, Tepper says.

“All the while, parents should remember that they don’t have to have all the answers,” he adds. “Practice, interest, and persistence are what make the biggest difference in their child’s results.”

Support goes beyond medical care, too, especially as your child grows. Children with hearing aids can be self-reliant and supported at home but are stigmatized or stigmatized at school or where they live. That’s why children with hearing loss also need emotional support, a community, and an environment they love. Every child needs to be seen, supported, and able to succeed.

My daughter went for a check-up after she was discharged from the hospital, so our trip stopped there. But if your child is diagnosed as deaf or hard of hearing, my most important advice is to trust your instincts as a parent and please remember this: Hearing loss is a disability, but it does not define what your child can do.