Here in Ontario, hearing screenings are done on every newborn baby. Typically, they’re completed in the hospital in the first day or two following birth, but there are also outpatient clinics for those who are discharged quickly. Little Oats failed the 24 hour screening because her ears were plugged up, but by the time we had the more in-depth screening done a few weeks later, all was good.

With Baby Oats, we were home from the hospital within 3 hours of his birth. The hearing screening slipped my mind for the first few weeks, and by the time I mentioned it to my midwives (who assumed the Infant Hearing Program had contacted me), Baby Oats was 6 weeks old.

We took him for his screening at a local clinic. It’s a relatively easy procedure, best done when babies are sleeping, the ABR (automatic brainstem response) test measures how the brainstem reacts to sounds when they are presented at different pitches. Small receptors are placed behind the baby’s ears and on the forehead, and they measure the responses. The first screening is really just that — a quick scan that results in a pass/fail result. Most babies will pass with no problem at all, especially when they’re sleeping soundly and nothing is interfering with the test.

Baby Oats had a tough time falling asleep for the test, but I did manage to get him down finally. He hated the probe in his ear (used to present the tones or clicks), but settled in enough to allow the test to work. He failed, three times in a row. I wasn’t really nervous; after all, Little Oats had failed as well, and she turned out to be totally fine. Plus, Baby Oats was just getting over a cold; it was possible that the fluid in his ears was causing a false negative on the test. The audiologist doing the test reassured me that she sees ‘fail’ results on many tests that end up being just fine, but that she still had to refer me to the pediatric audiologist at the hospital. A few weeks later, I got a call from the hospital asking us to come in for Baby Oats’ in-depth hearing test. I was relieved that it was booked so quickly; we had been told not to expect a call so early.

I was surprised at how involved the test would be. I was told to make sure Baby Oats was awake but ready to go to sleep – at eleven weeks old, that’s a little difficult to ensure. But we did our best, and I took him into the office shortly after ten in the morning. After swaddling him tight, the audiologist attached the sensors to his forehead and ears again. This test monitored the same brainstem response, just over different pitches (and for a much longer time). I rocked Baby Oats to sleep, and the test began.

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His responses were tested at three different pitches – 500Hz, 2000Hz and 4000Hz. Each of these pitches is tested at a variety of volumes, from about 10dB through to 50dB or higher, depending on response. Normal response rates are in around 25dB or less. Two other tests are typically done at this appointment: the OAE and the tympanogram. A tympanogram measures how the tympanic membrane (eardrum) reacts to sounds presented. The OAE measures the otoacoustic emissions – the sounds or echoes produced by the inner ear in response to a stimulus. Atypical results on either of these tests can indicate a problem with the middle ear or inner ear.

We were in the audiologist’s office for about an hour and a half, completing all of these tests. I was shocked at how well Baby Oats cooperated – he slept through the whole thing, and barely woke as I shifted him around. As I was sitting there, in the dark, quiet sound booth, I was so grateful for my training in speech and hearing. I can only imagine how nerve-wracking it must be for the majority of parents, sitting there, holding their sleeping baby, unaware of what the constant lines and graphs generating on the screen meant. I was fortunate enough to have a general sense of what was going on…and unfortunately I knew that it wasn’t good.

Baby Oats has a hearing loss. Though he only failed the initial screen in his left ear, both ears show a decline in hearing. In official terms, he has a mild/moderate conductive hearing loss. It is worse in the left than the right, and worse in the lower pitches. My stomach sunk as the audiologist was explaining it to me, and I left the hospital nervous and unsure of where to go from here. Thankfully, a chat with my work friend gave me a few reassurances. Because it’s a conductive loss, that means that it’s a physical issue preventing the sound from travelling through the ear. Typically, the issues causing a conductive loss can be treated, whether it’s fluid in the ear, a blockage, or a closed ear canal. The other type of hearing loss, sensorineural, is more serious, because it can’t be fixed; it’s an issue with the inner ear or auditory nerves. His tympanogram was flat or ‘Type B,’ which means that there was no response from the eardrum. This means that there is a bunch of fluid in his ear, which is also a solveable problem. Usually, around age two, tubes can be placed in the eardrum which drains this fluid and resolves underlying hearing loss. Though he has a hearing loss, it is mild enough that it shouldn’t affect his language development.

Because I’m a speech therapist, I know several tactics to aid in language development, but even if I weren’t, children are amazingly resilient. Baby Oats will use lipreading and facial cues to fill in any of the gaps his hearing leaves behind. To some extent, we all use these cues to add to what we can hear. I’m nervous, but I’m reassured that everything is going to be just fine. I know that it could be so much worse.

There’s nothing they will do for Baby Oats at this point; we’re just going to wait and see how it goes. At every doctor’s visit, they will examine the fluid in his ears to make sure that it isn’t infected; he is at a higher risk of ear infections because of the fluid sitting there. We’ll also get a referral to an ear nose and throat specialist, just to make sure there’s no reason for the hearing loss other than the fluid. I’m thankful for the information I’ve been provided from school, work and friends, and I know that ultimately, Baby Oats will thrive regardless.

Is hearing screening mandatory where you are? If you have a child with hearing loss, how are things going?