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Indiana State Department of Health

Indiana State Department of Health

Hearing Testing for Newborns & Children Hearing Testing for Newborns & Children

If your baby did not pass his/her newborn hearing screen, he/she should have his/her hearing evaluated by an audiologist as soon as possible. An audiologist is a health care provider who specializes in working with people with hearing loss.Every child who does not pass his or her newborn hearing screen should be referred for a diagnostic hearing evaluation. This evaluation is done to determine how a baby is hearing, as well as look for possible causes of a baby’s hearing loss.

It is important for parents to know that not every baby who did not pass his or her newborn hearing screen actually has hearing loss.

  • Sometimes the baby is too noisy (moving or crying) for accurate screening.
  • Often there is vernix (which normally is found on a baby's skin at birth) in the ear canal, which can affect the screening test.
  • Sometimes there is fluid in the middle ear space.

It is important to have the diagnostic assessment completed before three months of age to learn how your baby is hearing.

Your baby’s birthing facility or primary care provider should help you with making an appointment for your baby to be seen by an audiologist for additional hearing testing. You can also contact an audiologist on your own by clicking here and calling the audiology facility closest to your home. The Indiana State Department of Health Early Hearing Detection and Intervention (EHDI, pronounced “Eddie”) Program can also help you.

Diagnostic Testing for Hearing Loss

Diagnostic testing uses the automated auditory brainstem test and other tests to determine how your baby hears. The tests can be done at various loudness levels and at different pitches (high sounds and low sounds). If testing is done before your baby is 3 months of age, the tests can usually be completed while your baby sleeps. For older or more active babies, medicine may be needed to help your baby sleep during the tests. It is important for babies to be quiet and not move much during testing, so the results of the diagnostic testing are accurate.

In order to determine how your baby hears, an audiologist should use the following tests:

Diagnostic Auditory Brainstem Response (also called the ABR)

During the Auditory Brainstem Response test, sounds are played into the baby’s ear at various loudness levels (measured in decibels, or dB) and pitches (also called frequencies). During the test, these sounds will be played through earphones placed directly into the baby’s ears. A bone oscillator (which vibrates, or moves, against the bone behind the ear or the forehead) will also be used during the ABR to determine what type of hearing loss a baby has.

Otoacoustic Emissions (also called OAE)

During the OAE test, sounds are played into the baby’s ear through a small earphone placed in the baby’s ear. A microphone measures an echo response from the inner ear. This information helps define the type of hearing loss. Diagnostic otoacoustic emissions are usually used with the ABR and other hearing test results.


This test is used to determine how the eardrum and middle ear are working. During a tympanogram test, a small earphone is placed in the baby’s ear canal and air pressure is gently changed. This test is helpful in showing if there is an ear infection or fluid in the middle ear. This test is important because fluid or other problems in the middle ear can affect hearing.

Once a baby is between 6 and 9 months of age, an audiologist will attempt to test your baby’s hearing using pure tone behavioral testing. This means that the audiologist will present a series of tones (sounds) to your baby and observe him or her for a change in behavior each time a new sound is introduced. Babies will often move or change their facial expressions (such as smiling or crying) after hearing a sound. A behavioral pure-tone audiogram is done in a sound-proof room (also called a booth) to make sure that no extra noises are heard by your baby during the test. Pure tone information will give you and the audiologist information about how your baby responds to sounds of different pitches (frequencies).

What are types of pure tone tests?

Air Conduction

During an air conduction test, sounds are played into the baby’s ears through earphones placed directly in the baby’s ear. This type of pure tone test gives you and the audiologist information about how all parts of your baby’s ear are working.

Bone Conduction

During a bone conduction test, sounds are produced by a bone oscillator, which is placed on the baby’s forehead. A bone conduction test will give you and the audiologist information about your baby’s sensorineural function (or how your baby’s inner ear is working).


  • An audiogram is a picture of the softest sounds a person can hear.
    • The numbers across the top refer to the frequency (or pitch) of sounds presented during the audiogram. Lower frequencies represent lower sounds, such as the lowest notes on a piano. The higher frequencies represent higher sounds, such as the highest notes on a piano. Frequencies are measured in Hertz (Hz).
    • The numbers down the side refer to the intensity (or loudness) of sounds that the ear can hear. Lower numbers on the scale refer to softer sounds. High numbers on the scale refer to louder sounds. Intensity or loudness are measured in decibels (dB).
    • A circle on the audiogram represents the softest sound the right ear can hear.
    • An “X” on the audiogram represents the softest sound the left ear can hear.

  • Be sure to ask your child's audiologist for more information about your child's audiogram.