Primary Care Clinical Pathway for
Hearing Screening at Well Child Visit
0 - 6 Months
6 Months - 3 Years
Over 3 Years
Review Newborn Screening Results
Evaluate Risk Indicators
Evaluate Risk Indicators
Routine Development Surveillance
Evaluate Risk Indicators
Evaluate Risk Indicators
Screening Schedule
Baseline standards follow
the AAP guidelines.
Baseline standards follow
the AAP guidelines.
At 4, 5, 6, 8 and 10 Years old well visits, and once between 11-14 years, once between 15-17 years, and once between 18-21 years
Passed, No Risk Indicator(s)
Routine Developmental Surveillance
Failed, Unable to Screen or Risk Indicator(s)
Refer to Audiology
Routine Developmental Surveillance
Failed, Unable to Screen or Risk Indicator(s)
Refer to Audiology
Screen all patients in each ear at 20 dB HL
@ 1000 Hz, 2000 Hz, 4000 Hz
For patients 11-21 years, also screen
at 20dB HL @ 6000 Hz and 8000 Hz
Screening Procedure
@ 1000 Hz, 2000 Hz, 4000 Hz
For patients 11-21 years, also screen
at 20dB HL @ 6000 Hz and 8000 Hz
Screening Procedure
PCP Ear Exam
No Ear-related Pathology
Refer to Audiology
Refer to Audiology
Ear-related Pathology
Treat as indicated
Re-screen in office
Treat as indicated
Re-screen in office
No Risk Indicator(s)
Screening at
Next Annual Visit
Screening at
Next Annual Visit
No Ear-related Pathology
Refer to Audiology
Refer to Audiology
Ear-related Pathology
Refer to ENT
Refer to ENT
- Routine Developmental Surveillance
- For all children, regular surveillance of developmental milestones, auditory skills, parental concerns, and middle-ear status should be performed in the medical home, consistent with the AAP Pediatric Periodicity Schedule.
- Screening Schedule
- At 4, 5, 6, 8 and 10 years old well visits, and once between 11-14 years, once between 15-17 years, and once between 18-21 years
- Hearing Screening Procedure
- Interpret Results
Posted: October 2015
Revised: November 2022
Authors: McKay, S., AuD.; Biggs, L., MD; Germiller, J., MD, PhD; Macaulay, C., RN, CSN, CEN; Peterson, J. AuD
Educational Media
- Primary Care Perspectives: Podcast for Pediatricians
Episode 6: Noise-induced Hearing Loss - My Child Failed the Hearing Screening at Their Well Visit — Now What?
- My Baby Failed the Newborn Hearing Screening — Now What?
CHOP Program