Hearing Screening Online Training Program

Subjective Screening

Subjective screening (look for the “S” symbol on the C&TC Schedule of Age-Related Screening Standards) consists of information obtained verbally or in writing in response to the screener’s questions. When performing a subjective hearing screening, these questions are related to a history of childhood hearing disability or hearing loss in the family of the child's biological mother or father, delay in the child’s language acquisition or history of such delay, and the child having a history of repeated otitis media. The child, parent, or guardian must be asked if they have concerns about the child's hearing.

Hearing History
(Often conducted by primary care provider as part of health history)
Ages/Grades Birth through 20 years
Purpose To determine if medical factors exist to put the child at risk for hearing loss
Description A review of health history questions with parent or caregiver
Equipment C&TC documentation form or medical chart; pen
Facilities Comfortable private interview area
Procedure Ask the hearing history questions
Interpretation of Results Pass/No Pass Criteria

Hearing History Questions

1. Is there concern that this child has a hearing problem?
2. Are there any hearing problems that started in childhood in the family of the child’s biological mother or father? (This question is important as the incidence of hearing problems is more prevalent in children whose biological parents had hearing problems as children.)
3. Does the child have a history of chronic ear infections and/or tubes?
4. Has the child had serious head trauma, concussion, skull fracture, or loss of consciousness since the last C&TC visit?
5. Has the child been hospitalized with a serious illness, especially meningitis or kidney disease, since the last C&TC visit?

For complete information on Hearing History documentation, see C&TC Documentation section.

The parent or caregiver should be asked whether they have observed any of the following potential indicators of hearing loss:

Complaints or Behaviors:

  • Pain in ear(s)
  • Fullness in ear(s)
  • Noise in ear(s)
  • Drainage from ear(s)
  • Cannot hear
  • Tugs at ear(s)
  • Asks to have things repeated
  • Turns side of head towards speaker
  • Inattentive to conversation
  • Watches speakers’ lips
  • Shows strain when listening
  • Difficulty with phonics
  • Tends to isolate
  • Talks too loudly or softly
  • Has a speech problem
  • Not working to capacity in school
  • Frequent mistakes in following directions
  • Day dreaming

Complaints regarding the child’s hearing or observed abnormal listening behaviors should be noted on the C&TC documentation form ["Attention: By selecting the link above you will be leaving the Minnesota Department of Health Web site."] or medical chart and further evaluation should be made.

For complete information on Hearing History documentation, see C&TC Documentation section.

Joint Commission on Infant Hearing (JCIH) High Risk Indicators

  • The high risk indicators for hearing loss should be used when newborn hearing screening has not been conducted
  • Age groups for high risk indicators are
    • Birth to 28 days
    • 29 days to 2 years

Explanation of High Risk Indicators

My Child’s Hearing Checklist
(When screening children aged 0 to 24 months, provide the My Child’s Hearing Checklist form to the parent to complete. Any concerns from this checklist should be documented under the Hearing Concerns section of the C&TC documentation form ("Attention: By selecting the link above you will be leaving the Minnesota Department of Health Web site.") or the patient’s medical chart. "My Child's Hearing Checklist" is available from the National Center for Hearing Assessment and Management (NCHAM) in Somali, Hmong, Spanish, and English.