OAE Protocol for Newborn Hearing Screening
For universal newborn hearing screening, OAE testing should be performed as a rapid 10-minute screening test using a small probe placed in the ear canal, testing each ear separately, with infants who fail referred for repeat testing between 2-8 weeks after discharge. 1, 2
Initial Screening Protocol
Timing and Technique
- Perform OAE screening prior to hospital discharge, ideally after the first 24 hours of life to minimize false positives 1, 3
- The pass rate improves significantly with infant age: 72.5% when tested in first 24 hours versus 93.6-97.9% when delayed to days 2-5 3, 4
- Optimal screening window is 36-48 hours of age, achieving pass rates of 73.1% for OAE 4
- Average test time is approximately 3.5 minutes per infant, significantly faster than ABR 4
Test Procedure
- A small probe containing a sensitive microphone is placed in the ear canal for stimulus delivery and response detection 1
- The test delivers either clicks or tone bursts and measures acoustic signals generated from the cochlea 1
- Test each ear separately to obtain ear-specific results 1
- The infant must remain relatively inactive during testing 1
- The automated screener provides a simple pass-fail report requiring no audiologist interpretation 1
Critical Limitations to Recognize
High Sensitivity to Interference
- OAEs are extremely sensitive to middle-ear effusions, cerumen, and vernix in the ear canal, leading to false positives 1
- This explains the high initial failure rate of 12.1% in first-phase screening 5
- OAE does not assess cortical processing of sound—it only tests cochlear function, not true hearing 1
What OAE Misses
- Approximately 23% of infants with permanent hearing loss at 9 months will pass a two-stage OAE/ABR protocol because OAE primarily detects moderate-to-severe losses 6
- 77% of missed cases have mild hearing loss (≤40 dB) 6
- OAE cannot detect auditory neuropathy or neural hearing loss 2, 7
Follow-Up Algorithm
For Failed Initial Screening
- Refer for repeat OAE testing between 2-8 weeks after discharge 2, 7
- 87.3-87.5% of infants who fail initial screening will pass the second OAE 5, 3
- If repeat OAE is performed on day 5 of life (coinciding with metabolic screening), it decreases false positives and improves family compliance 3
For Failed Second Screening
- Refer directly for comprehensive audiological evaluation including diagnostic ABR testing, which can be performed as early as 3 months of age 2, 7
- Do not perform additional OAE rescreening 2, 7
Special Population: NICU Infants
- Infants with NICU admission ≥2 days must be screened with ABR technology, not OAE alone, due to risk of neural hearing loss 2, 7
- If ABR fails in NICU, refer directly to audiologist rather than for outpatient OAE rescreening 2
Quality Indicators to Monitor
Program Performance Metrics
- Target ≥95% coverage of all newborns in first-phase screening 5
- Referral rate to third phase (diagnostic testing) should be approximately 2.9% 5
- Confirm diagnosis before 4 months of age in >90% of referred cases 5
- Loss to follow-up should be minimized, though 13-31% of infants who fail initial screening do not return 2, 7
Counseling Families
- Only 2% of infants who fail OAE screening in low-risk populations actually have sensorineural hearing loss 2
- False-positive results produce significant anxiety in 3-14% of parents even after normal follow-up 2, 7
- Communicate results face-to-face in a caring and sensitive manner 2
Risk Factors Requiring Enhanced Surveillance
High-Risk Infants Need Ongoing Monitoring
- Any infant with risk factors requires at least one diagnostic audiology assessment by 24-30 months of age, regardless of newborn screening results 2, 7
- Risk factors include: family history of childhood hearing loss, craniofacial abnormalities, congenital infections, syndromes associated with hearing loss, and NICU admission 2
- 50-75% of infants with moderate-to-profound bilateral hearing loss have identifiable risk factors 2