What is the recommended frequency of audiology hearing screening across different ages and risk factor profiles?

Recommended Frequency of Audiology Hearing Screening

All children should receive objective hearing screening at newborn, 4,5,6,8,10,12,15, and 18 months, then periodically throughout childhood; adults should be screened every 3 years starting at age 50, with more frequent screening (every 1-3 years) after age 65. 1

Pediatric Population (Birth to 18 Years)

Universal Newborn Screening

• All newborns should receive hearing screening before hospital discharge, with diagnosis confirmed by 3 months of age and intervention initiated by 6 months 1, 2
• NICU infants admitted for more than 5 days require ABR testing (not just OAE) to detect neural hearing loss 1

Well-Child Visit Screening Schedule

• Objective screening at specific ages: newborn, 4,5,6,8,10,12,15, and 18 months 1
• Age-appropriate screening tools should be selected based on developmental stage 1
• Ongoing surveillance of communicative development should begin at 2 months during all well-child visits 1

High-Risk Children Requiring Enhanced Surveillance

Children with any risk factor must receive at least one diagnostic audiology assessment by 24-30 months of age, regardless of passing newborn screening 1

Risk factors requiring ongoing monitoring include:

• Cytomegalovirus (CMV) infection - requires more frequent assessments 1
• Extracorporeal membrane oxygenation (ECMO) - requires more frequent assessments 1
• Syndromes associated with progressive hearing loss 1
• Family history of childhood hearing loss 1, 2
• Craniofacial anomalies 1
• Hyperbilirubinemia requiring exchange transfusion 2
• Culture-positive sepsis 2
• Ototoxic medication exposure 1

Parental Concern Triggers Immediate Screening

Any parental concern about hearing loss requires objective screening immediately, regardless of screening schedule 1

• Parents often identify hearing loss 12 months before physicians 1
• This concern should never be dismissed without objective testing 1

Adult Population (Age 50 and Older)

Age-Related Hearing Loss Screening

Starting at age 50, screen every 3 years; after age 65, increase frequency to every 1-3 years 1, 3

The WHO recommends:

• Ages 50-64: screening every 5 years 1
• Ages 65+: screening every 1-3 years 1

However, the most recent AAO-HNS guideline (2024) suggests more aggressive screening every 3 years starting at age 50, with annual screening at clinician visits being cost-effective 1

Screening Methods for Adults

Simple, validated approaches include:

• Single question: "Do you have difficulty with your hearing?" 1
• Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) 1
• Handheld audiometry at 3 kHz at 25,40, and 60 dB 1
• Pure-tone screening at 1,2, and 4 kHz at 25 dB HL 4

Special Populations Requiring Intensive Monitoring

Childhood Cancer Survivors

Children treated with platinum-based chemotherapy or cranial radiotherapy require ongoing audiological surveillance 1

• Hearing function may deteriorate over time after treatment 1
• Frequency should be customized based on specific risk factors 1
• Younger age at treatment increases risk 1

Developmental Disabilities

Children with autism, developmental delay, or behavioral problems require:

• Referral to pediatric audiologist with specialized expertise 1
• Standard screening may not be accurate in this population 1

Critical Implementation Points

Failed Screening Follow-Up

• Infants failing initial screening need repeat testing at 2-8 weeks after discharge 2
• If second screening fails, comprehensive audiological evaluation by 3 months 2
• 13-31% of infants who fail initial screening are lost to follow-up - aggressive tracking is essential 2

Cost-Effectiveness Considerations

• Hearing screening is cost-effective at approximately £800-1000 per quality-adjusted life-year 5
• Earlier screening (starting at age 50) and more frequent intervals (every 3 years) are supported by cost-effectiveness data 1

Common Pitfalls to Avoid

• Do not rely solely on pneumatic otoscopy or tympanometry - these assess middle ear function but do not evaluate hearing 1
• Do not delay diagnostic testing in children with risk factors even if they passed newborn screening 1
• Do not dismiss parental concerns - objective testing is mandatory 1
• Do not use pure-tone average (PTA4) alone in younger adults as it misses early high-frequency hearing loss 6
• Do not screen NICU infants with OAE alone - ABR is required to detect auditory neuropathy 1, 2