• Contact Us

    Newborn Screening Unit
    Texas Early Hearing Detection and Intervention (TEHDI)
    PO Box 149347, MC-1918
    Austin, Texas 78714-9347

    Fax: 512-776-7125
    Toll-free: 800-252-8023, ext. 7726


Next Steps in Newborn Hearing Screening

Next Steps if Your Baby Does Not Pass the Hearing Screening at the Birthing Facility or Is Not Tested Before You Leave the Facility

Step 1

  • Contact the birthing facility and determine if outpatient services are provided. 
  • If the birthing facility does not offer outpatient screenings, talk with your baby’s health care advocate or primary care physician and get a referral to a pediatric audiologist. For a pediatric audiologist in your local area, call OZ Systems at 1-866-427-5768, press option 6 and then press option 2.

Step 2 - If your baby does not pass the follow-up hearing screening

Your physician or a provider of the TEHDI program will refer you to the Early Childhood Intervention (ECI) program to help you with intervention services. A pediatric audiologist will do a number of tests on your baby to diagnose if your baby is hard of hearing or deaf. The testing can take several hours, and will probably happen across several visits to the office. The pediatric audiologist may recommend immediate amplification technology for your baby.

Step 3 - This step can happen while you are working on Step 2

  • ECI will work with you to develop a plan for your baby to receive the services that are needed. 
  • If there is a fee, it is minimal. If your family cannot afford to pay, you are not turned away for their services if your child is hard of hearing, deaf or has vision issues. 
  •  Within 45 days of referral to ECI, a team will help you complete evaluations for your child and create an Individual Family Service Plan.

Types of Hearing Tests

Automated Auditory Brainstem Response (AABR) – This screening is done by attaching small electrodes to the baby’s head, sending an auditory signal into the ear canal and through the neural part of the hearing system, and receiving the response to the signal in the auditory centers of the brain. This test shows whether the neural part of the auditory system is working. It takes around 10-15 minutes to perform and the results are automatically generated from the system.

Transient or Distortion Product Otoacoustic Emissions (OAE) ) – This screening is done by sealing off the outside of the ear canal with a small ear tip, sending an auditory signal into the ear canal and into the cochlea (the portion of the auditory system that converts the mechanical sound wave into electrical energy) and sends it on to the brain. If the cochlea is normal, it will respond to the auditory signal by sending a signal back. A tiny microphone in the ear tip picks up the signal. The testing takes 5-10 minutes and the results are automatically generated from the system.

Audiological Evaluation – An audiological evaluation, sometimes called a hearing assessment, is a group of tests that check different parts of the auditory system in order to identify the area of the auditory system that is not working appropriately. The results of the evaluation are often put on a graph called an audiogram which shows the areas of hearing loss (low, middle or high pitched sounds) and degree of hearing status (mild, moderate, profound). The unit of measure for hearing is the decibel (dB). The dB level for each frequency (pitch) is charted on the audiogram or another graph, depending on the testing done.

Difference between a Hearing Screening and a Diagnostic Hearing Evaluation

The purpose of the hearing screening is to quickly test one part of the auditory system to find out whether it is working properly. OAE tests the cochlea to see if it is working and the AABR tests the neural system to see if it is working. (See the section above on “Types of Hearing Tests” for screening details.) Diagnostic hearing testing uses the same methods of testing but checks at more frequencies and levels. Screening takes less than 10 minutes, and diagnostic testing takes two to three hours, and all parts of the hearing system are assessed. Testing is done while the baby is asleep. It may take more than one appointment to get all of the testing done. Your audiologist can explain all the tests, why they are being done, and what was found.

Resources Related to Hearing Loss in Infants and Young Children

  • The University of Texas at Dallas Callier Center for Communication Disorders has developed an online resource called Texas Connect. It covers a wide range of information from definitions and terms to state and national resources, information on navigating the Texas system, and answers about communication options for your child. The Texas Connect Guide is a good first step in getting information. Your audiologist and the staff at the ECI program will also be able to direct you to resources.
  • Texas has Pediatric Protocols for Audiology that describes diagnostic evaluation of babies who do not pass the birth hearing and follow-up screens.
  • EHDI-PALS (Pediatric Audiology Links to Services) is a web-based link to information, resources, and services for children with hearing loss. At the heart of EHDI-PALS is a national web-based directory of facilities that offer pediatric audiology services to children who are younger than five years of age. EHDI- PALS is a project of the CDC.

    TEHDI Program’s Role in Hearing Screening

    • Provides a system and technical assistance to licensed birthing facilities and other hearing services providers under the statute.
    • Certifies birthing facilities and monitors certification standards for newborn hearing screening programs.
    • Ensures that newborns who are diagnosed as hard of hearing or deaf receive follow-up and intervention services.

    Other State Agencies Involved in the Hearing Detection and Intervention Process

    • The TEHDI program works closely with the Department of Assistive and Rehabilitative Services (DARS) through two programs, Early Childhood Intervention (ECI) and the Office for Deaf and Hard of Hearing Services (DHHS), to ensure the follow-up and intervention piece. A two-page chart showing the 1-3-6 month guide to the hearing screening and intervention process is available. View the 1-3-6 Guide.
    • DARS-ECI has a Memorandum of Understanding with the Texas Education Agency for Auditory Impairment services through the Local Education Agency (LEA).
    • Once a child is referred to ECI, an evaluation and an Individual Family Service Plan will be developed within 45 days, identifying other needed services.
    • Identified services are available to age 35 months through ECI, at which time ECI and the LEA coordinate transition services when the child reaches three years of age.

    Challenges in Reporting Follow-up Screenings and Professional Services

    • Texas has the second highest birth rate in the nation with approximately 387,000 births in 2012.
    • Approximately 79% of the follow-up screenings performed are reported to DSHS. The HRSA grant efforts are making it possible to follow more of the babies, but the results of this effort will not be fully known for another year.
    • It is estimated that only about 10% of Texas audiologists are pediatric audiology specialists. This leaves some areas of Texas, primarily rural, without local pediatric audiologists, and families must drive to nearby urban cities for services. It is encouraging to note that more audiologists are including pediatric testing in their practices, and the TEHDI Program is hopeful that the numbers will continue to grow.

    Areas of the Hearing System

    The hearing system can be divided into four areas: the outer ear, the middle ear, the inner ear, and the auditory centers of the brain. The hearing system can have something go wrong in any single area, or a combination of areas. The audiologist will perform a group of tests to find the area(s) that are involved in the status of your baby’s hearing.

    Inner ear diagram

    Outer ear:
    The outer ear includes the ear and the ear canal that goes down to the eardrum. Evaluation of this area includes visual inspection with an instrument called an otoscope, and clearing of wax and other debris from the ear canal, if needed.

    Middle ear: Diagram of cochlea
    The middle ear includes the eardrum (tympanic membrane), the bones in the middle ear space, and the Eustachian tube, which keeps the atmospheric pressure inside the middle ear cavity equal to the pressure in the air around us. Fluid in this space can cause hearing problems when a baby has fluid behind the eardrum as a result of allergies or infection.

    Tympanometry is a test done to check the middle ear. If the middle ear space is filled with fluid, hearing loss can be a result. Hearing status issues resulting from a problem in the outer and/or middle ear is called conductive and can often be managed medically. If the problem in this area cannot be medically managed, amplification may be appropriate.

    Inner ear:
    The inner ear structures include the cochlea and the balance mechanism. The cochlea changes sound from vibration to an electrical signal and sends the signal along the acoustic nerve to the brain. If a hearing status problem happens in the cochlea, it is called sensorineural and most often can be assisted with amplification. If there is a hearing status problem in both the middle ear and inner ear, it is called mixed.

    Central auditory system (brain):
    If the auditory centers of the brain, located in the temporal lobe, are not functioning properly, the hearing status issue is called neural. This means that the signal is getting to the brain but the brain cannot understand it.

    Scale of Hearing Impairment Based on the Pure-Tone Average at 500, 1000 and 2000 Hz

    Scale of Hearing Impairment
    Pure Tone Average
    in Decibels
    Degree of 
    Communication Impact 
    Amplification Options 
    Communication Training
    -10 to 15 None No No
    16 to 20 Slight Possibly Possibly
    21 to 40 Mild Probably Probably
    41 to 70 Moderate Definitely Definitely
    71 to 90 Severe Definitely Definitely
    90 + Profound* Definitely Definitely
    *Cochlear implant may be considered with this degree of communication impact.
    (Information excerpted from Introduction to Audiology, Frederick N. Martin & John Greer Clark, Eighth Edition, used with permission.)




    Last updated April 27, 2022