University of Edinburgh

Supporting Deaf Pupils in the Early Stages: Learning from Good Practice

Presented on Wednesday 4 February 2009

Early years support provided by health services and partnership working at this early stage

Dr Juan Mora
Consultant Audiological Physician
RHSC – Glasgow

Early years support …
The UNHS (Universal Newborn Hearing Screening Programme) has introduced considerable changes in the work of Paediatric Audiology Departments.

UNHS implemented in Glasgow in Oct 05.

10053 babies screened (1/4/07 to 31/3/08)
(Glasgow residents only)
(Public Health Screening Programmes Annual Report 2007 – 2008)

Epidemiology: UK = 840 children/year born
with permanent hearing loss
(40 dB HL or more in better ear 0.5-1-2-4 kHz)

400 not identified by 1 ½ years
200 not identified by 3 ½ years

A critical review of the role of neonatal hearing screening in the detection of congenital hearing impairment.
Davis A, Bamford J, Wilson I, Ramkalawan T, Forshaw M, Wright S
Health Technol Assessment 1997; 1(10).

UNHS Greater Glasgow (1/4/07 to 31/3/08)
Babies screened: 10053
Bilateral hearing loss confirmed in 14 babies

Mean age at diagnosis: 62 days

(Glasgow residents only)
(Public Health Screening Programmes Annual Report 2007 – 2008)

Target Audience: this day will be very valuable to teachers of deaf children working with deaf children at the early stages.

Parents are informed in writing about the UNHS via leaflets provided in the antenatal sessions and as the baby progresses through the screening.

your baby's hearing screen

your baby's visit to the audiology clinic

your baby has a hearing loss


Early years support …
Greater Glasgow UNHS program

  • 2 stage program delivered in 3 maternity units by 13 hearing screeners and 1 manager plus administration staff.
  • Screening test: AABR: Automated Auditory Brainstem Evoked Responses.

AABR testing

AABR screening: Right PASS Left REFER

AABR screening

Bilateral PASS: Discharged unless there are
Risk Factors for Late onset/Progressive hearing loss
(to Surveillance clinic at 12 and 36 months of age).

Parents are given checklists for REACTION TO SOUNDS and MAKING SOUNDS. They are encouraged to seek a referral if they have any concern regarding the hearing of their child.

Document for Parents:

Below are checklists which you might find useful to look at as your baby grows older. If you are ever worried about your baby's hearing please contact your Health Visitor or GP.

1. Checklist for Reaction to Sounds

Shortly after birth - a baby
Is startled by a sudden loud noise such as a hand clap or a door slamming.
Blinks or opens eyes widely to such sounds or stops sucking or starts to cry.

1 month - a baby
Starts to notice sudden prolonged sounds like the noise of a vacuum cleaner and may turn towards the noise.
Pauses and listens to noises when they begin.

4 months - a baby
Quietens or smiles to the sound of familiar voice even when unable to see speaker and turnes eyes or head towards the voice.
Shows excitement at sounds, eg; voices, footsteps etc.

7 months - a baby
Turns immediately to familiar voice across the room or to very quiet noises made on each side (if not too occupied with other things).

9 months - a baby
Listens attentively to familiar everyday sounds and searches for very quiet sounds made out of sight.

12 months - a baby
Shows some response to own name. May also respond to expressions like "no" and "bye bye" even when accompanying gesture cannot be seen.

Checklist for Making Sounds

4 months - a baby
Makes soft sounds when awake. Gurgles and coos.

6 months - a baby
Makes laughter-like sounds
Starts to make sing-song vowel sounds eg; a-a, muh, goo, der, aroo, adah

9 months - a baby
Makes sounds to communicate in friendliness or annoyance. Babbles (eg; da da da, ma ma ma, ba ba ba)
Shows pleasure in babbling loudly and tunefully. Starts to imitate other sounds like coughing or smacking lips.

12 months - a baby
Babbles loudly, often in a conversational-type rhythm
May start to use one or two recognisable words.

Early years support …


Babies with Refer or NCR ("no clear response") result uni-

Diagnostic assessment session
History / Otoscopy by Audiologist
ABR (Auditory Brainstem Responses)
[Air and bone conducted clicks, frequency specific tone pips and cochlear microphonic response]
Tympanometry (High frequency)
TEOAEs (Transient evoked otoacoustic emissions test) or bilaterally are referred to the Audiology Dpt. (RHSC).

High frequency tympanometry (1 kHz)


Right Ear: Click ABR

right ear


When hearing loss is identified on the diagnostic session:
The Audiologist and Audiological Physician discuss the test results immediately.

The child and family are seen on the same day by the Audiological Physician.

The Audiological Physician (on the 1st and subsequent follow-up visits):

  • History + Clinical examination
  • Clinical findings and tests results explained
  • Aetiological investigations outlined/requested
  • Management plans outlined (medical and non-medical)
  • Referral to the Early Intervention Team

Early Intervention Team

  • Audiologist
  • Sensory Support Service *
  • Educational Audiology *
  • Speech and Language Therapy
  • WSDCS (West of Scotland Deaf Children Society)
  • Associate Specialist (Audiology)
  • Consultant Audiological Physician

(* Colleagues from other areas invited to the team meetings)

  • Amplification provided at 3 months of age.
  • Audiologist will review monthly until 2 years of age (Audiological Physician informed of outcome via Practice Navigator report plus verbally when required).
  • Visual Reinforcement Audiometry at 6/12 of age.
  • Audiological Physician will see at least 6 monthly at this stage.

Information from appointments with Audiologists and Audiological Physician shared with Parents, Sensory Support Service, Educational Audiologists, Speech and Language Therapists, GPs, Health Visitors and Social Worker, Paediatrician and other professionals as required.