Newborn Hearing Screening Protocol

Initial Screening

The American Academy of Pediatrics recommends performing OAE screening prior to hospital discharge, ideally after the first 24 hours of life, to minimize false positives 1
A small probe containing a sensitive microphone is placed in the ear canal for stimulus delivery and response detection, and the test delivers either clicks or tone bursts and measures acoustic signals generated from the cochlea 1, 3, 4
The test should be performed on each ear separately to obtain ear-specific results 1, 5
The automated screener provides a simple pass-fail report requiring no audiologist interpretation 3, 4

OAEs are extremely sensitive to middle-ear effusions, cerumen, and vernix in the ear canal, leading to false positives 1, 3, 4
OAE does not assess cortical processing of sound—it only tests cochlear function, not true hearing 5, 6, 7
OAE cannot detect auditory neuropathy or neural hearing loss 2, 8

Refer for repeat OAE testing between 2-8 weeks after discharge if the initial screening is failed 2, 8
If repeat OAE is failed, refer directly for comprehensive audiological evaluation including diagnostic ABR testing 2, 8
Infants with NICU admission ≥2 days must be screened with ABR technology, not OAE alone, due to risk of neural hearing loss 2, 8

Loss to follow-up should be minimized, though 13-31% of infants who fail initial screening do not return 2, 8
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, 8

Any infant with risk factors requires at least one diagnostic audiology assessment by 24-30 months of age, regardless of newborn screening results 2, 8
50-75% of infants with moderate-to-profound bilateral hearing loss have identifiable risk factors 2