Screening for hearing loss in childhood: issues, evidence and current approaches in the UK

TLDR

Childhood hearing loss screening in the UK evolved from infant distraction and school entry tests to a national newborn hearing screening programme, driven by evidence of early identification benefits and the underperformance of earlier screens, yet challenges such as late‑onset loss, mild/unilateral cases, and optimal intervention remain. This study reviews the effectiveness of the first phase of the national newborn hearing screening programme, completed in 2005. The authors outline current research efforts aimed at addressing unresolved issues in childhood hearing loss screening and management.

Abstract

Until recently, screening for childhood hearing loss in the UK was based on two universal (i.e. whole population) screens: the infant distraction test screen at age eight months and the school entry hearing screen at age four to five years. Evidence reviewed in the 1990s indicated that the infant distraction test screen was seriously underperforming, but that (based on technology that had become available in the 1980s and 1990s) universal newborn hearing screening could be efficacious. At the same time, evidence was emerging on the importance and value of very early identification and intervention for permanent congenital childhood hearing loss. This led to the decision to implement a national newborn hearing screening programme (NHSP) in England and to phase out the distraction test at eight months. The initial implementation of the programme will be completed in 2005, and we summarize the evidence on the effectiveness of the first phase of the programme here. A number of important issues concerning childhood hearing loss and its management remain unresolved: the burden of late-onset and temporary childhood hearing losses, the most effective approaches to intervention and management, the case for screening for mild and/or unilateral hearing loss, and the role of the School entry screen. Some of the current research efforts to address these are outlined.