Auditory Brainstem Response (ABR) Screening

Why Is A Newborn Hearing Screening Important?  

Newborn hearing screen is part of Florida’s protocol to ensure the health of your babies’ ears and hearing. A test is typically completed before the baby leaves the birthing center. The hearing screening is easy, not painful and is usually performed while the child is asleep or awake and calm.

Types of Hearing Screeners


Automated Otoacoustic Emissions (AOAEs)

AOAE is a machine that tests different frequencies and looks to elicit a response back from the inner ear cells. This screener is conducted by placing a small probe in the baby’s ear and playing different sounds. The results are typically on a pass or refer basis.

Image of a baby's ear

Automated Auditory Brainstem Response (AABR) 

AABR is a machine that determines if a response from the brain was measured when a sound was played. This screener is conducted by placing electrodes (stickers) on the baby’s forehead and behind each ear and placing a small ear bud in each ear.  The results are typically on a pass or refer basis. 

What If My Baby Does Not Pass The Newborn Hearing Screening?  

It is important to follow-up after a refer result to confirm the newborn has adequate access to sounds to prevent delays in speech and language development.

A hearing screen result is typically a ‘pass’ or ‘refer’. A referring result does not confirm hearing loss, it means further diagnostic information is needed to determine hearing status. A newborn is referred for a diagnostic evaluation after two failed hearing screens.

A family history of hearing loss in parents or siblings, and medical conditions may also require diagnostic testing to ensure the hearing status of the newborn. 

Image of father with children

Types of Diagnostic Testing



Tympanometry is the assessment of middle ear function. This test can be used to determine if the eardrum is moving normally or abnormally. Tympanometry is completed by placing a small probe tip at the entrance of the patient’s ear and sending a gentle puff of air into the ear to move the eardrum. Abnormal readings on this test can indicate the presence of fluid, negative pressure, or a hole in the eardrum.


Otoacoustic Emissions (OAEs)

Otoacoustic emissions is a sensitive test of inner ear cochlear function. This test is completed by placing a small probe in the patient’s ear. Different tones are presented to each ear individually and as a result, a healthy ear will create an “echo” back that can be measured. When we can measure that “echo,” it indicates normal function of the important cells in the inner ear.


Auditory Brainstem Response (ABR) Evaluation 

The ABR evaluation is a diagnostic test that determines the neural integrity of the auditory system or when and how the brain interrupts the sound. This evaluation is used for infants who have referred two hearing screenings or who are suspected to have hearing loss. An ABR can be performed in the office via natural sleep and can be done for newborns till 5 months of age.

The ABR is conducted by placing electrodes (stickers) on the baby’s forehead and behind each ear and placing a small ear bud in each ear. This test allows the audiologist to screen for Auditory Neuropathy Spectrum Disorder (ANSD) and is also used to estimate hearing thresholds to determine degree and type of hearing loss if present. 


Warning Signs of Hearing Loss in Newborns  

  • Does not startle or react to sounds
  • Seems to hear certain loud sounds and not others 
  • Does not seek out or detect where sound is coming from
  • Has stopped babbling and experimenting with making sounds
  • Still babbles but is not moving to more understandable speech
  • Does not react to voices, even when being held
  • Ear is missing or malformed at birth


Other Signs of Hearing Loss in Newborns 

  • Concern for hearing and or speech/language development
  • Family history of permanent childhood hearing loss
  • Neonatal Intensive Care Unit (NICU) stay for 5 days or longer 
  • History of jaundice requiring blood transfusion  
  • Low birth weight < 1500 grams  
  • Lack of oxygen during pregnancy (anoxia)   
  • In utero infections: CMV, herpes, rubella
  • Craniofacial anomalies or syndromes associated with hearing loss   
  • Cardiac or respiratory support (ECMO)
  • Chemotherapy