Mild-moderate congenital hearing loss: secular trends in outcomes across four systems of detection

Mr Peter Carew1,2, Dr Fiona Mensah1,2,3, Associate Professor Gary Rance2, Dr Traci Flynn4, Dr Zeffie Poulakis1,2,3, Professor Melissa Wake1,2,3,5

1Murdoch Childrens Research Institute, Parkville, Australia,

2The University of Melbourne, Parkville, Australia,

3Royal Children’s Hospital, Parkville, Australia,

4Karolinska Institutet, Stockholm, Sweden,

5The University of Auckland, Auckland, New Zealand

Background: Universal newborn hearing screening (UNHS) often targets moderate or greater hearing loss, but frequently detects children with mild loss. This results in many receiving early treatment, without firm evidence of benefit.

Aims: (1) compare language and psychosocial outcomes between four hearing loss detection systems for children aged 5-8 years with congenital mild-moderate hearing loss; (2) determine whether age of detection predicts outcomes; and (3) compare outcomes between children identified via well-established UNHS and the general population.

Methods: Linear regression adjusted for potential confounding factors was used throughout. Language and psychosocial outcomes were compared across four population-based Australian systems of hearing loss detection: opportunistic detection, born 1991-1993, n=50; universal risk factor referral, born 2003-2005, n=34; newly established UNHS, born 2003-2005, n=41; and well-established UNHS, born 2007-2010, n=21. In pooled analyses, we examined whether age of detection predicted outcomes. Outcomes were similarly compared between the current well-established UNHS system and typically-developing children (Early Language in Victoria Study, born 2003, n=1217).

Results: For moderate losses, mean expressive language and receptive vocabulary improved across the systems, but benefit was not evident for mild losses. Diagnosis before age six months predicted better language outcomes for moderate, but not mild, losses. Children with mild-moderate losses exposed to well-established UNHS continue to experience lower expressive language than typically developing children.

Conclusions: UNHS may be resulting in treatment that is not benefitting children with mild hearing losses. Rigorous trials are needed to quantify benefits, versus costs and potential harms, of early aiding for children with mild losses.


Peter Carew originally trained as an audiologist and has spent most of his clinical career in infant and paediatric diagnostics. He has worked for Victoria’s UNHS service, and continues to hold a teaching position at the University of Melbourne in the Master of Clinical Audiology degree. Most recently, Peter has undertaken his PhD studies within the Centre of Research Excellence in Child Language, based at the Murdoch Childrens Research Institute. The focus of his doctoral studies was on the outcomes of children born with mild and moderate bilateral hearing loss.