Otoacoustic emissions (OAE) screening is a non-invasive hearing test that detects acoustic signals from the inner ear. Speech-language pathologists use OAE screening to identify hearing loss in newborns, infants, and patients who can’t self-report, making it essential for early intervention programs.
- Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
- Grand Canyon University - Online Master of Science in Speech-Language Pathology. - This STEM program focuses on training aspiring speech-language pathologists to offer compassionate, effective services to individuals with communication disorders
- Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.
- NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
- Pepperdine University - Embark on a transformative professional and personal journey in the online Master of Science in Speech-Language Pathology program from Pepperdine University. Our program brings together rigorous academics, research-driven faculty teaching, and robust clinical experiences, all wrapped within our Christian mission to serve our communities and improve the lives of others.
Otoacoustic emissions screening has transformed how speech-language pathologists and audiologists detect hearing loss, especially in populations that can’t communicate their hearing difficulties. This simple, painless test takes less than a minute but provides critical information that can change a child’s developmental trajectory.
Understanding how to perform and interpret OAE screening is essential for SLPs working in schools, hospitals, and early intervention settings. This guide covers everything you need to know about OAE screening procedures, applications, and best practices.
What Are Otoacoustic Emissions?
Otoacoustic emissions (OAEs) are acoustic signals generated by the inner ear when it receives sounds. These emissions are essentially echoes produced by tiny hair cells called stereocilia in the cochlea. When sound enters the ear, these stereocilia vibrate and convert sound impulses into electrical signals that travel to the brain through the auditory nerve.
In people with normal hearing, these otoacoustic emissions can be detected using specialized probes inserted into the ear canal. If the inner ear has been damaged or if something blocks the sound pathway from the outer ear, these emissions won’t be present or will be significantly reduced.
This physiological response forms the basis for a simple, objective test that doesn’t require any response from the patient. The discovery of OAEs has revolutionized newborn hearing screening programs worldwide.
How OAE Screening Works (Procedure & Technology)
OAE screening measures how well the cochlea responds to sound using simple, non-invasive technology that takes just seconds to produce results.
OAE screening uses a small handheld device with a soft probe tip that’s placed in the ear canal. The device plays a series of clicking sounds or tones into the ear. If the cochlea is functioning normally, the hair cells respond by producing their own sounds (the otoacoustic emissions), which the probe’s sensitive microphone detects and measures.
The Science Behind the Test
The test works because healthy cochlear hair cells don’t just passively receive sound. They actively amplify sound vibrations through a process called cochlear amplification. This amplification is so precise that it creates measurable sound waves that travel back out through the middle ear. These are the otoacoustic emissions that the test detects.
When hair cells are damaged by noise exposure, ototoxic medications, genetic conditions, or other factors, they can’t produce these emissions. This makes OAE screening an excellent objective measure of cochlear function.
Types of OAE Tests
Two main types of OAE tests are used in clinical practice:
Transient Evoked OAEs (TEOAEs): These use brief clicking sounds and are most commonly used for newborn screening programs. They’re quick and effective for identifying hearing loss of 30-40 decibels or greater.
Distortion Product OAEs (DPOAEs): These use two simultaneous pure tones at different frequencies. They’re more frequency-specific and can test hearing at different pitches, making them useful for monitoring ototoxicity or noise-induced hearing loss.
When & Why SLPs Use OAE Screening
Speech-language pathologists perform OAE screening across multiple settings to identify hearing loss early and ensure appropriate intervention.
Speech-language pathologists perform OAE screening in various settings, though they may refer more complex cases to audiologists for comprehensive evaluation. Understanding when to use OAE screening is essential for effective practice.
Newborn Hearing Screening Programs
The most widespread application of OAE screening is in newborn hearing programs. The U.S. Early Hearing Detection and Intervention (EHDI) program, active in all 50 states, has achieved high screening rates, with the most recent data showing over 98% of newborns screened for hearing loss shortly after birth (though reporting varies by state and year).
This early detection system has been transformative. Research from the National Institutes of Health shows that children who receive early intervention for hearing loss demonstrate significantly improved language outcomes. Studies indicate that a substantial majority of children identified with hearing loss enter intervention programs within their first year, though rates vary by state and program effectiveness.
Early detection and intervention have been shown to support language skills and social development in children with hearing loss to levels more comparable to their hearing peers when services begin before 6 months of age.
School-Based Screening
School-based SLPs use OAE screening as part of periodic hearing assessments from early childhood through school age. In many states, hearing screenings occur every 1-3 years, though requirements vary significantly by jurisdiction. These screenings can identify:
- Late-onset or progressive hearing loss
- Temporary hearing loss from ear infections
- Unilateral (one-sided) hearing loss
- Noise-induced hearing loss in older students
Clinical and Hospital Settings
In clinical settings, SLPs use OAE screening when patients have communication difficulties but can’t reliably respond to traditional hearing tests. This includes:
- Very young children (under 3 years)
- Patients with developmental disabilities
- Individuals with cognitive impairments
- Patients who are unconscious or sedated
- Anyone suspected of functional hearing loss
Step-by-Step Procedure Guide
Following proper OAE screening procedures ensures accurate results and positive patient experiences for all age groups.
Performing OAE screening correctly ensures accurate results and a positive patient experience. Here’s the complete procedure:
Pre-Test Preparation
1. Check the environment: OAE testing requires a quiet space. Excessive background noise can interfere with the sensitive microphone and produce false failures. You don’t need a soundproof booth, but choose the quietest available room.
2. Otoscopic examination: Always begin with a visual inspection of the ear canal using an otoscope. Look for:
- Excessive earwax that could block the probe
- Foreign objects in the ear canal
- Signs of infection or inflammation
- Structural abnormalities
Any blockage or abnormality can prevent OAEs from being detected and will result in a failed screening even if hearing is normal.
3. Select the appropriate probe tip: Choose a soft, flexible probe tip that fits snugly in the ear canal without causing discomfort. The probe needs a good seal to detect emissions accurately.
Testing Procedure
4. Position the patient: For infants, testing works best when they’re sleeping or calm. Older children and adults should sit quietly. Movement and crying create noise that interferes with the test.
5. Insert the probe: Gently insert the probe into the ear canal at a slight angle, following the natural curve of the canal. For infants, gently pull the pinna up and back. The probe should rest comfortably with a snug seal.
6. Start the test: Activate the device. Most OAE screeners run automatically once the probe is properly sealed. The test typically takes 30 seconds to 2 minutes per ear, depending on the device and how still the patient remains.
7. Monitor the screen: Watch for indicators that show:
- Adequate probe fit
- Acceptable noise levels
- Test progress
- Pass/refer result
8. Test both ears: Always test both ears, even if you only suspect hearing loss in one ear. Unilateral hearing loss is common and important to identify.
Post-Test Actions
9. Document results: Record the results for both ears, noting any factors that may have affected testing (such as the child crying or excessive ambient noise).
10. Interpret and explain results: Communicate findings to parents or patients in clear, non-technical language (see the next section for interpretation guidelines).
Interpreting Results
Understanding what pass and refer results mean helps SLPs provide appropriate guidance and referrals to families.
OAE screening provides a simple pass/refer result, but understanding what these results mean is crucial for appropriate follow-up.
Pass Result
A pass indicates that the cochlea is responding normally to sound and otoacoustic emissions are present. This suggests:
- Cochlear hair cells are functioning
- No significant hearing loss (at least in the frequencies tested)
- The sound pathway from the outer ear to the cochlea is clear
A pass result doesn’t completely rule out all types of hearing problems. According to ASHA guidelines, OAE screening may not detect auditory neuropathy spectrum disorder (where the cochlea works but the auditory nerve doesn’t transmit signals properly) or mild hearing loss in some frequency ranges.
Refer Result
A refer (or fail) result means emissions weren’t detected adequately. This could indicate:
- Hearing loss affecting the cochlea
- Blocked ear canal (wax, vernix in newborns, debris)
- Middle ear fluid or infection
- Poor probe fit during testing
- Excessive noise during the test
A refer result doesn’t confirm hearing loss. Many factors can cause a refer result in children with normal hearing. This is why follow-up testing is essential.
When to Retest vs. Refer
If a screening results in a refer:
- Retest immediately if testing conditions weren’t optimal (noise, movement, poor seal)
- Retest in 1-2 weeks if middle ear fluid is suspected (common in infants and young children)
- Refer to audiology if the retest still results in a refer
- Refer immediately if there are risk factors for hearing loss or developmental concerns
Complementary Testing
OAE screening is often paired with other tests for a complete picture:
Tympanometry: This air pressure test checks middle ear function and can identify fluid, eardrum perforations, or eustachian tube problems. It’s especially useful when OAE screening fails because it helps determine if the issue is in the middle ear rather than the cochlea.
Pure Tone Audiometry: For older children and adults who can respond reliably, pure tone audiometry provides detailed information about hearing thresholds at different frequencies. This behavioral test complements the objective information from OAE screening.
Auditory Brainstem Response (ABR): When OAE results are unclear or hearing loss is confirmed, ABR testing can assess the entire auditory pathway from ear to brainstem. This is the gold standard for diagnosing hearing loss in infants and can identify auditory neuropathy spectrum disorder.
OAE vs. Other Hearing Tests
Comparing OAE screening to other hearing assessment methods helps SLPs choose the most appropriate test for each patient and situation.
Understanding how OAE screening compares to other hearing tests helps you choose the right assessment for each patient.
| Test Type | What It Measures | Patient Cooperation Needed | Test Duration | Best Used For |
|---|---|---|---|---|
| OAE Screening | Cochlear hair cell function | None (just need to be quiet) | 30 seconds – 2 minutes per ear | Newborns, young children, screening programs |
| Pure Tone Audiometry | Hearing thresholds at specific frequencies | Yes – must respond to sounds | 10-15 minutes | School-age children and adults with reliable responses |
| Tympanometry | Middle ear function and pressure | Minimal (must stay still) | 30-60 seconds per ear | Detecting middle ear problems, fluid, and infections |
| Auditory Brainstem Response (ABR) | The entire auditory pathway function | Must be asleep or sedated | 1-2 hours | Diagnostic follow-up, auditory neuropathy diagnosis |
Advantages of OAE Screening
- Speed: Results in under a minute make it ideal for screening large populations
- Objectivity: Doesn’t rely on patient response, eliminating false negatives from uncooperative patients
- Non-invasive: Completely painless and safe for all ages
- Cost-effective: Portable equipment and quick testing make it economical for screening programs
- Early detection: Can identify hearing loss in the first days of life
Limitations of OAE Screening
- Doesn’t test entire pathway: According to CDC and ASHA guidance, OAE screening can’t detect auditory neuropathy spectrum disorder or problems beyond the cochlea
- Sensitive to middle ear issues: Fluid or infection causes false failures
- Limited frequency range: May miss hearing loss at very low or very high frequencies
- Requires a quiet environment: Background noise can interfere with results
- Pass/refer only: Doesn’t quantify the degree of hearing loss
Best Practices for SLPs
Implementing evidence-based protocols and clear communication strategies ensures effective OAE screening programs and appropriate patient care.
Follow these guidelines to ensure accurate screening and appropriate follow-up.
Program Management
If you’re responsible for managing a screening program, establish clear protocols:
- Develop written procedures for testing, documentation, and follow-up
- Create parent communication materials in multiple languages
- Understand state regulations regarding EHDI programs and parental consent
- Establish referral pathways to audiologists for diagnostic testing
- Track follow-up rates to ensure children who fail screening receive appropriate care
Communication with Families
When communicating results to parents or caregivers:
- Use clear, non-technical language (hearing screening rather than otoacoustic emissions)
- Explain what a refer result means without causing undue alarm
- Emphasize that many results are due to temporary conditions like fluid
- Provide written information about the next steps
- Ensure families understand the importance of follow-up testing
- Offer support and resources for families of children with confirmed hearing loss
Continuing Education and Competency
Maintain your skills and knowledge through:
- Regular equipment calibration and maintenance
- Periodic review of testing protocols
- Staying current with ASHA guidelines for hearing screening
- Understanding state-specific requirements and regulations
- Participating in quality assurance reviews of screening programs
Scope of Practice Considerations
While SLPs can perform OAE screening, recognize when to refer:
- Repeated failed screenings require a comprehensive audiological evaluation
- Complex medical histories warrant referral to audiology
- Diagnostic testing and hearing aid fitting are outside the SLP’s scope
- Collaborate with audiologists for optimal patient care
Documentation Requirements
Maintain thorough records, including:
- Date and time of screening
- Equipment used and calibration status
- Test results for both ears
- Testing conditions and any factors affecting results
- Recommendations and referrals made
- Parent notification and follow-up plans
Frequently Asked Questions
What’s the difference between OAE screening and a hearing test?
OAE screening is a quick test that checks if the cochlea (inner ear) is functioning normally. It’s not a complete hearing test. A full hearing test (audiometry) measures exactly how well someone can hear different sounds at various volumes and frequencies. Think of OAE screening as a first check – it tells us if there might be a problem, but it doesn’t tell us everything about someone’s hearing. If OAE screening identifies a potential issue, a comprehensive hearing test by an audiologist provides the complete picture.
Can OAE screening detect all types of hearing loss?
No, OAE screening can’t detect all types of hearing loss. It specifically checks cochlear hair cell function, so it’s excellent for identifying sensorineural hearing loss affecting the inner ear. However, it can’t detect auditory neuropathy spectrum disorder (where the cochlea works but the nerve doesn’t transmit signals properly) or problems with the auditory nerve and brain. It also may not identify very mild hearing loss in some frequency ranges. This is why failed screenings need follow-up with comprehensive diagnostic testing, including Auditory Brainstem Response (ABR) when necessary.
Why do so many newborns fail the initial OAE screening?
It’s common for newborns to fail initial OAE screenings even when their hearing is normal. This happens because newborns often have fluid or vernix (the white, waxy coating) in their ear canals right after birth. These temporary blockages prevent the probe from detecting emissions. That’s why newborns who fail the initial screening are retested before hospital discharge or within a few weeks. Most babies who fail the first screening pass when retested once their ears have cleared.
Do SLPs need special certification to perform OAE screening?
Requirements vary by state. OAE screening is generally within the SLP scope of practice as defined by ASHA, but some states require specific training or certification. Many employers provide training on their specific equipment and protocols. It’s important to check your state’s licensure requirements and practice act. Even without state-mandated certification, completing training on proper technique, equipment operation, and result interpretation ensures accurate screening and appropriate follow-up.
How often should children receive OAE screening?
Screening frequency depends on the setting and risk factors. All newborns should be screened before hospital discharge. In many states, school-age children receive hearing screenings every 1-3 years, though requirements vary significantly by jurisdiction. Children with risk factors for hearing loss (frequent ear infections, family history, exposure to loud noise, certain medical conditions) may need more frequent screening. Children receiving speech therapy should have their hearing checked if they aren’t making expected progress.
What should I do if a child fails OAE screening multiple times?
If a child fails OAE screening twice (with proper technique in quiet conditions), refer them to an audiologist for comprehensive diagnostic testing. Don’t continue rescreening beyond two attempts – this delays necessary intervention if hearing loss is present. The audiologist will perform more detailed testing, including ABR (Auditory Brainstem Response) if needed, which can diagnose hearing loss definitively and determine its type and degree. Document all screening attempts and ensure the family understands the importance of follow-up.
Can ear infections affect OAE screening results?
Yes, ear infections and middle ear fluid significantly affect OAE results. Even if the cochlea is working perfectly, fluid in the middle ear prevents sound from reaching the inner ear properly and blocks emissions from traveling back out. This results in a failed screening. If you suspect an ear infection or see signs during otoscopic examination, note this in your documentation and recommend the child be rescreened after the infection clears (typically 2-4 weeks after treatment). This is also why tympanometry is often performed alongside OAE screening.
Key Takeaways
- OAE screening is a fast, objective test that detects cochlear function by measuring acoustic emissions from inner ear hair cells, making it ideal for screening infants and patients who can’t self-report.
- The test requires minimal patient cooperation – subjects only need to be quiet for 30 seconds to 2 minutes. This makes it perfect for newborn screening programs, which have achieved screening rates above 98% in many states.
- A pass indicates normal cochlear function, while a refer result requires follow-up testing but doesn’t confirm hearing loss. Many factors, like earwax, fluid, or movement, can cause false failures.
- OAE screening has important limitations – according to ASHA and CDC guidance, it can’t detect auditory neuropathy spectrum disorder, problems beyond the cochlea, or some types of mild hearing loss. Failed screenings need a comprehensive audiological evaluation.
- SLPs use OAE screening across multiple settings, including newborn nurseries, schools, and clinical environments. Understanding proper technique, result interpretation, and referral protocols ensures effective screening programs.
- Early detection through OAE screening enables early intervention, which research shows supports language development and social skills in children with hearing loss when services begin before 6 months of age.
- Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
- Grand Canyon University - Online Master of Science in Speech-Language Pathology. - This STEM program focuses on training aspiring speech-language pathologists to offer compassionate, effective services to individuals with communication disorders
- Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.
- NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
- Pepperdine University - Embark on a transformative professional and personal journey in the online Master of Science in Speech-Language Pathology program from Pepperdine University. Our program brings together rigorous academics, research-driven faculty teaching, and robust clinical experiences, all wrapped within our Christian mission to serve our communities and improve the lives of others.
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Medical Disclaimer: This article is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Speech-language pathologists should follow their state licensing requirements, facility protocols, and ASHA guidelines when performing hearing screenings. Always consult with or refer to licensed audiologists for comprehensive diagnostic hearing evaluations.