Hearing Behaviour Reflex – Complete Nursing Notes for NORCET
GK Nursing Quiz (gknursingquiz) • High-yield summary, skill steps, red flags, and 10 interactive MCQs
Table of Contents
What is the Hearing Behaviour Reflex?
Hearing Behaviour Reflex (also called the auditory startle/behavioral response) refers to observable, automatic reactions to sound—like blinking, startle (Moro), eye-widening, cessation of sucking, or arousal. These reflexes help nurses quickly screen hearing in newborns and infants and guide when to do formal tests such as Otoacoustic Emissions (OAE) or Auditory Brainstem Response (ABR).
Exam key: Remember cochleo-palpebral reflex = blink response to a sudden loud sound; auditory startle (Moro to sound) peaks in the neonatal period and reduces by ~3–6 months as cortical control improves.
Age-wise Normal Behavioural Responses to Sound
| Age | Typical Response to Sound |
|---|---|
| Newborn (0–1 mo) | Startle/Moro to loud sound, cochleo-palpebral blink, cessation of movement/sucking |
| 1–3 months | Quiets to caregiver’s voice, startle decreases, eyes widen, attends to sound source |
| 4–6 months | Turns head toward sound laterally, responds to own name; laughs/babbles |
| 7–9 months | Localizes sounds better; enjoys sound toys; babbling with variety |
| 10–12 months | Understands simple words; consistent head turn/localization |
Remember: Persistent absent startle/blink to loud sounds in early months is a red flag—refer for OAE/ABR.
Clinical Uses in Nursing Practice
- Rapid bedside screening in postnatal ward, NICU follow-up, immunization clinics.
- Counseling parents on normal vs. abnormal responses and the need for formal hearing screening.
- Triage & referral: If behavioral responses are absent or delayed → schedule OAE / ABR.
How to Assess Behavioural Hearing Reflex (Bedside)
- Ensure a quiet environment, infant calm/alert (not deep sleep or crying vigorously).
- Use a sudden broad-band sound (hand clap out of visual field, soft shaker, approved sound source ~70–90 dB for startle). Avoid visual cues.
- Observe for blink (cochleo-palpebral), startle, arousal, cessation of sucking, eye widening, or head turn depending on age.
- Test both sides by changing the sound source direction; allow rest between stimuli.
- Document the response (present/absent, consistency, side). If doubtful → repeat later when infant is calm.
- Refer for OAE/ABR if responses persistently absent, asymmetric, or developmentally inappropriate.
Safety: Do not use excessively loud or repeated startling sounds. Protect infant comfort and avoid distress.
Red Flags Requiring Early Referral
- No startle/blink to loud sound in a quiet room in the first weeks of life.
- No head turn/localization by 6 months.
- Delayed babbling, poor response to name by 9–12 months.
- Risk factors: NICU stay >5 days, ototoxic drugs, hyperbilirubinemia exchange, family history of hearing loss, craniofacial anomalies, meningitis.
High-Yield Nursing Points for NORCET
- Cochleo-palpebral reflex = blink to loud sound (present in newborns).
- Moro to sound is an auditory startle; reduces by ~3–6 months.
- Behavioural tests are screening; OAE checks outer hair cells; ABR checks auditory nerve/brainstem.
- Normal newborn screening: OAE within first days; if fail → repeat or ABR; persistent fail → ENT/audiology.
- Always check for transient conductive causes (vernix, canal debris, otitis media with effusion).
FAQs: Hearing Behaviour Reflex (Student Friendly)
1) Is startle reflex to sound same as Moro?
Yes, a sudden loud sound can elicit the Moro (auditory startle) in newborns. It typically diminishes by 3–6 months.
2) What is cochleo-palpebral reflex?
A blink response to a sudden loud sound; useful as a quick bedside check in neonates.
3) My infant doesn’t blink to loud sound—what next?
Repeat when calm in a quiet room. If still absent, refer for OAE/ABR without delay.
4) Are behavioural responses enough to declare hearing loss?
No. They’re screening signs. Confirm with OAE/ABR and ENT/audiology evaluation.
5) When should routine newborn hearing screening be done?
Ideally before discharge or within the first month; follow the 1-3-6 rule: screen by 1 month, diagnose by 3 months, intervene by 6 months.
Practice: 10 MCQs (Click an option; correct answer reveals explanation)
1) The cochleo-palpebral reflex is best described as:
The cochleo-palpebral reflex is a blink response triggered by an abrupt loud sound—useful as a quick neonatal hearing screen.
2) In a healthy newborn, the auditory startle (Moro to sound) typically reduces by:
Startle is prominent in early months and diminishes by 3–6 months as cortical control matures.
3) A 2-week-old does not show blink or startle to loud clap in a quiet room after two attempts. Best next step?
Persistent absent behavioural responses in early infancy warrants objective screening with OAE/ABR and ENT/audiology follow-up.
4) Which is a behavioural indicator of hearing in a 5-month-old?
Head turn/localization around 4–6 months is a normal behavioural response; OAE/ABR/tympanometry are objective tests.
5) Which newborn is at higher risk for hearing loss?
NICU >5 days, ototoxic drugs, severe jaundice, meningitis, family history are known risk factors; needs closer screening.
6) OAE primarily evaluates which structure/function?
Otoacoustic emissions reflect outer hair cell integrity; ABR assesses auditory nerve/brainstem pathways.
7) A 7-month-old does not localize sound and rarely responds to name. First action?
Developmental red flags require prompt objective assessment; early detection improves outcomes.
8) During behavioural assessment, which technique is most appropriate?
Avoid visual cues and excessive loudness; ensure infant is calm for reliable observation.
9) Which statement is TRUE about behavioural hearing tests?
Behavioural responses guide referral; diagnosis requires objective audiological testing.
10) The 1-3-6 rule in hearing care means:
Early screening and intervention (by 6 months) is critical for language and cognitive outcomes.
Rapid Revision (1-Minute)
- Cochleo-palpebral = blink to loud sound (neonate).
- Startle (Moro) to sound fades by ~3–6 months.
- By 4–6 months: head turn toward sound.
- Behavioural = screening → confirm with OAE/ABR.
- Red flags: no blink/startle early; no localization by 6 months; no response to name by 9–12 months; NICU/ototoxic/jaundice risks → refer.
Keep Learning
Practice more topics for NORCET: Rinne & Weber tests, Newborn Reflexes, Growth & Development milestones, Neonatal jaundice care, etc. Save this page and revise before the exam!