Tennessee Hearing Screening Requirements for Newborns and School-Aged Children

The following information summarizes hearing screening programs for newborns and school-aged children.

The information has been collected by researching individual state statutes, regulations, policy documents, and by contacting each state. The information is reviewed on an annual basis. Please be advised that regulations and policy may change at any time, so always check with your state for the most up-to-date information.

Newborn Screening


Every newborn infant shall be screened for hearing loss in order to prevent the consequences of unidentified hearing loss.


Intervention is not addressed by laws/regulations.


Currently there are two technologies available for physiologic screening of hearing in newborns: Auditory brainstem response (ABR) and otoacoustic emissions (OAE). Automated physiologic hearing screening equipment does not require interpretation by the screener and is recommended if non-audiologists conduct the screening.

Screeners should be trained by individuals with experience in newborn hearing screening techniques and practice. Training should be competency based and involve hands-on components. Screeners may include audiologists, registered nurses, or other trained technical staff. Staff should meet facility employment requirements.


All screening providers or entities shall report their screening results to the Department of Health.

The Department of Health shall refer any child who does not pass the hearing screening test to the Tennessee Early Intervention System (TEIS) of the Department of Education for follow-up.

The state newborn hearing screening program will notify TEIS of infants reported that did not pass the hearing screening and have not had follow-up testing completed within 6 weeks of screening.

School-Age Screening

Tenneessee law encourages appropriate public schools, nursery schools, kindergartens, preschools or child care facilities to make reasonable efforts to apprise parents of the health benefits of obtaining appropriate eye, hearing and dental care for children upon registration or as early as is otherwise possible.

The Department of Education has issued School Health Guidelines.

Ages/Populations Screened

At a minimum, all students in pre-kindergarten, kindergarten, and grades 2, 4, 6, and 8 shall receive a hearing screening once a year. Screening one year of high school is optional however whatever year of high school that is selected must be then screened year after year. At any point a student can be referred for screening per local school district protocol.

Who Can Screen

Volunteers may be useful during the initial sweep screening to assist with the flow of students through the screening procedure. Some volunteers may be trained to conduct the initial sweep screen. Holding a volunteer instruction session is helpful for all new volunteers, and should be scheduled close to the day of the screening. During the training session, familiarize volunteers with the audiometers, screening forms and procedures. Having volunteers who feel comfortable with the equipment increases accuracy during the screening procedure. All volunteers should be counseled regarding confidentiality issues.

Training for Screeners

Screening program guidelines from the American Speech–Language-Hearing Association (1997) and American Academy of Audiology recommend that training for screeners be managed or supervised by an audiologist whenever possible.

Some screeners may opt to complete a formal training program and exam to obtain certification as an Occupational Hearing Conservationist through the Council for Accreditation in Occupational Hearing Conservation (CAOHC).

Type of Testing

Puretone audiometric testing

Equipment Standards

Equipment standards are not addressed by laws/regulations.

Follow-up Protocols & Documentation

Same-day (immediate) rescreening should be completed for children who refer on the initial screening. It is recommended that same-day rescreening be completed by a different screener on an alternate piece of equipment if possible. Children who fail the same-day rescreening should be rescreened a final time 6–8 weeks later.

A referral letter should be sent home to the parent with a recommendation that the student be seen by an audiologist. The nurse should notify the child's teacher(s) that the child has been referred for a possible hearing impairment. In addition to being alert to the possibility the child is having hearing difficulty, the school personnel are often in a position to reinforce the need
to follow through on the referral. It is important to monitor the child closely; documenting the nurse and teacher concerns for the effect the suspected hearing impairment is having on the child's education. These concerns need to be communicated to the parent/guardian. School personnel are encouraged to explore the reason for failure to follow-up on a hearing screening referral.
This may result in identification of the need for additional resources or information.

Until the student's hearing status is clearly defined by medical and/or audiological evaluation, the following measures should occur:

  1. The student should be given preferential seating so that he/she is in direct line of the teacher's/speaker's voice. Optimum distance is four to six feet from the teacher. If a better ear has been identified, the student's better ear should be closest to the teacher.
  2. Teachers should use appropriate clarification strategies to ensure that the student understands oral information (repeat, rephrase, speak louder or closer, etc.).
  3. Whenever possible, teachers should avoid:
    • Standing in front of a bright window while speaking.
    • Speaking while writing on the chalkboard (back to class).
    • Positioning themselves so that their faces are not visible to students
  4. Noisy learning environments should be avoided or minimized.


For further information on hearing screening requirements, visit these websites:

Questions regarding state advocacy issues? Call ASHA at 800-498-2071 and ask for the State Advocacy Team.

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