Newborn hearing screening — formative SAQs

SAQ 1 — Bilateral refer before rural discharge (20 marks, ~15 minutes)

A well term newborn is 28 hours old. Bilateral OAE screening is a refer. The family lives 2 hours from the regional diagnostic audiology service and wants same-day discharge. Father says, “He jumped when the door slammed, so his hearing is fine.” [7] [8]

Questions

1. Define pass, refer and incomplete in newborn hearing screening and state which applies here. (3 marks) [1]
2. Explain why a startle response does not exclude permanent hearing loss. (3 marks) [7]
3. Outline the 1-3-6 Early Hearing Detection and Intervention targets and the immediate disposition plan for this infant. (6 marks) [1]
4. Give four elements of plain-language counselling you would use with this family. (4 marks) [8]
5. List four system actions that reduce lost-to-follow-up after refer in rural families. (4 marks) [8]

Model answer anchors

1. Pass = screen clear for routine pathway; refer = more testing required; incomplete = not done/invalid/no owned plan. This infant is a bilateral refer. [1]
2. Newborn behavioural responses are crude and may reflect vibration or non-threshold pathways; they do not measure hearing thresholds. [7]
3. Screen by 1 month, diagnose by 3 months, intervene by 6 months. Discharge only with booked diagnostic audiology, working contacts, teach-back and a named owner. [1] [8]
4. Refer is not deafness; next test is diagnostic audiology; why timing matters for language; what to do if appointment fails; open questions welcome. [3] [8]
5. Book before discharge; transport support; interpreter if needed; dual contact numbers; active chase list; written and verbal plan. [8]

SAQ 2 — High-risk pass and later language concern (20 marks, ~15 minutes)

A former 30-week infant passed automated ABR near NICU discharge after ototoxic exposure. At 9 months corrected age there is reduced babble and poor response to quiet sounds. Newborn notes also mention possible congenital CMV testing that was never completed. [11] [15]

Questions

1. Why was an AABR-based pathway preferred over OAE-only screening in this infant? (4 marks) [1] [7]
2. Explain residual risk after a newborn pass in this case. (4 marks) [11] [12]
3. What is your immediate assessment and investigation plan now? (6 marks) [7] [17]
4. How would earlier confirmation of permanent loss have changed expected language trajectory? (3 marks) [2] [3]
5. Name three medical-home roles after permanent loss is confirmed. (3 marks) [13]

Model answer anchors

1. NICU populations have higher neural and illness-related risk; AABR includes pathway integrity beyond outer hair cells. [1] [7]
2. Progressive/late-onset loss can follow cCMV, ototoxicity and other high-risk pathways despite a newborn pass. [11] [12]
3. Urgent diagnostic audiology, developmental assessment, complete cCMV evaluation per local timed pathway, caregiver history, ear examination, and safety-net while awaiting tests. [7] [11]
4. Earlier identification/confirmation is associated with better language and supports better long-term literacy trajectories. [2] [3] [5]
5. Coordinate early intervention, track development/vision/family function, support school readiness and access barriers. [13]