Pass/fail rates for repeated click-evoked otoacoustic emission and auditory brain stem response screenings in newborns.

The click-evoked otoacoustic emission (EOAE) recording procedure is a simple and quick test to perform. Some suggest that the EOAE is a more efficient newborn hearing screening procedure than the auditory brain stem response (ABR). However, one shortcoming of the EOAE is a high false-positive rate in newborns, which is attributed to ear-canal debris. The purposes of this study were to assess the initial pass/fail rates of ABR and EOAE measurements and the effectiveness of repeated EOAE measurements as a method of reducing the false-positive rate. Fifty healthy, low-risk newborns sequentially underwent ABR, repeated EOAE, otoscopy, EOAE, and ABR if necessary. The initial ABR passing rate was 98%, whereas the EOAE passing rate was 61%. The EOAE passing rate improved with each retest and approximated the ABR rate by the fourth test. EOAE failures and the overall level of the EOAE were found to be significantly related to the amount of ear-canal debris. These results indicate that some newborns will require four or more tests before they eventually pass. Further study is needed to determine the overall cost-effectiveness of the EOAE as compared with the ABR before specific recommendations for a universal hearing screening program are proposed.