The Healthy Hearing Protocols and Guidelines have been produced with the objective of ensuring newborn
hearing screening uniformity across all screening sites, both public and private, in Queensland. This document
provides an overarching set of protocols and guidelines to achieve consistency of practice across the state.
The layout of these protocols has been designed to allow quick access to relevant sections of the document.
To maintain control of this document, screening sites are encouraged to use the online version of the Healthy
Hearing Protocols and Guidelines. This assures that they are referring to the most current and correct version
of the document. It can be accessed from the CHQ Website at Resources | Children's Health Queensland.
1.1 Program Background/Rationale
Permanent childhood hearing loss (PCHL) is a common congenital anomaly. The incidence of PCHL in
newborns is more frequent than any individual condition included in neonatal metabolic screening, with 1 to 2
babies per 1000 births diagnosed with a significant hearing loss (HL).1,2,3 More than half of children diagnosed
with a HL come from the well-baby population, born without any known hearing loss risk factors such as
family history or medical conditions associated with HL.
The detection of HL in the first 12 months of life can be difficult without the use of technology and often
escapes detection by parents and/or the physician until the child fails to attain language milestones. However,
recent technological advancements have produced a range of valid and reliable automated instruments that
can now be used to screen newborn babies for hearing loss. Access to these instruments has enabled the
establishment of cost-effective screening programs for PCHL such as the Healthy Hearing Program. Prior to
the introduction of newborn hearing screening in Queensland, the average age of identification of a HL was
approximately 30 months (2.5 years).
Early detection of HL in infants is of paramount importance, with age of identification and age of enrolment
in intervention being the key variables for achieving optimal language development. International and local
evidence suggests that detection of a HL and commencement of early intervention through hearing aid
provision and communication habilitation by the age of 6 months may be critical for speech and language
development, and the child’s future learning and social outcomes.
In line with a growing body of research on the importance of early identification of hearing loss, and in
response to community initiative, Queensland Health implemented a universal newborn hearing screening
program called the “Healthy Hearing Program” (HHP). More than 60,000 babies are born in Queensland
each year and all Queensland birthing facilities (public and private) offer newborn hearing screening
Clinical History
CLINICAL HISTORY is documented. No Surveillance referral to Audiology is required
Data required due to potential for clinical relevance.
The below conditions are recorded on the S&R form under Clinical History, and added to the Acculink
device in the usual way, but NO referral is made to Audiology
Condition Description / Features
Prolonged Ventilation ≥ 120 hours of IPPV, CPAP, HHFNCT
Bacterial meningitis Does not include viral meningitis
Hyperbilirubinaemia ≥ exchange transfusion levels per appropriate Nomogram
for baby. Record highest level, date and time.
Professional concern Infant has Cardiopulmonary bypass/ECMO, maternal
cisplatin in pregnancy, IVH grades 3 and 4
Guidelines for Assessing Practical Competencies
Specific competencies that must be demonstrated at the completion of training are detailed in the
following table.
Theoretical knowledge
& understanding of
evidence for universal
newborn hearing
screening (UNHS)
Demonstrates:
• a clear understanding of basic anatomy & physiology of the ear
• a basic understanding of the different types of hearing loss
• a clear understanding of the impact of a HL on speech & language development
• a good understanding of the State-wide and local policy in relation to screening
protocols and procedures
• a clear understanding of the circumstances in which a child is listed for follow-up
and identify the procedures involved
Can explain:
• the benefits of early identification of a hearing loss and resulting early intervention
and/or management
• the normal developmental milestones for hearing and the importance of
monitoring those with all babies