[Hinews] Congenital hearing loss affects approximately five out of every 1,000 newborns, making it a relatively common auditory condition. However, congenital hearing loss often goes unnoticed at birth, since newborns may cry or respond in ways that appear normal to parents and healthcare providers. Given that hearing in the neonatal period directly influences language development and brain growth, delayed diagnosis can lead to significant challenges, including language delays, learning disabilities, and emotional or social difficulties.

Children who miss newborn hearing screening are typically diagnosed around 30 months of age—well beyond the critical window for language development. Missing this period can have lasting negative impacts on education and social integration. Early detection and intervention, therefore, are the cornerstone of effective management for congenital hearing loss.

The ‘1-3-6 Rule’: A Global Standard for Early Intervention

Countries like the United States and Germany adhere to the internationally recognized “1-3-6 rule” to ensure timely identification and rehabilitation of congenital hearing loss:
  • 1 month: Conduct hearing screening.

  • 3 months: Confirm diagnosis with follow-up testing.

  • 6 months: Begin auditory rehabilitation.

This framework is designed to support timely language acquisition and preserve social communication skills. Some nations maintain national databases to track children requiring follow-up or confirmation testing, with public funding often allocated to ensure seamless access to rehabilitation services.

Early screening, timely diagnosis, and rehabilitation are critical in determining a child’s language development and quality of life. (Image courtesy of ClipArtKorea)
Early screening, timely diagnosis, and rehabilitation are critical in determining a child’s language development and quality of life. (Image courtesy of ClipArtKorea)


Since 2018, South Korea’s national health insurance has covered newborn hearing screening, ensuring that all infants can be tested within their first month of life. Screening typically occurs before hospital discharge using automated auditory brainstem response (AABR) or otoacoustic emissions (OAE) tests, both of which are non-invasive and efficient.

If abnormalities are detected, a comprehensive diagnostic evaluation follows. From this stage, tailored interventions such as hearing aids, cochlear implants, or speech therapy are implemented.

Seamless Care: From Screening to Diagnosis to Rehabilitation

When a newborn is referred for further testing after screening, parents should not dismiss the result as temporary. Completing confirmatory testing by three months of age and initiating interventions—such as hearing aids, cochlear implantation, or speech therapy—by six months is pivotal for maximizing treatment outcomes.

Delays beyond this critical period can hinder language and cognitive development, reducing the effectiveness of interventions. If the brain’s window for language acquisition closes, even robust auditory rehabilitation may not fully restore typical language development.

Photo: Professor Ji-won Jang, Department of Otolaryngology, Korea University Anam Hospital
Photo: Professor Ji-won Jang, Department of Otolaryngology, Korea University Anam Hospital

Even newborns who pass initial screenings require vigilance if they fall into high-risk categories for hearing loss. These include:

  • History of neonatal intensive care unit (NICU) admission

  • Premature birth

  • Family history of hearing loss

  • History of perinatal or early-life viral infections

  • Exposure to ototoxic medications (drugs that can damage hearing)

Children in these high-risk groups remain vulnerable to mild, delayed-onset, or progressive hearing loss. Regular hearing assessments and ongoing monitoring throughout early childhood are therefore essential.

Expert Perspective: The Need for Systemic Support

Dr. Ji-won Jang, a professor of otolaryngology at Korea University’s Anam Hospital, oversees South Korea’s government-funded program for newborn hearing screening and pediatric hearing aid support. “With timely intervention, children with congenital hearing loss can achieve positive outcomes in both language acquisition and social development,” Dr. Jang emphasized. “However, it’s not enough to stop at screening. A structured system that seamlessly connects screening, diagnosis, and rehabilitation is essential, and sustained national support is critical to making this a reality.”

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