In Brief:
Otoacoustic emissions (OAEs) are widely used in neonatal hearing screening (NHS) programs, but some factors limit their effectiveness. A relatively high false positive rate is common, partly due to physiological noise affecting the OAE recording and causing a mistaken refer outcome. To reduce false-positive screening outcomes related to noise, tone-burst-evoked otoacoustic emissions (TBOAEs) were included in a NHS program. TBOAEs may elicit a greater signal-to-noise ratio in the OAE recording than conventional click-evoked otoacoustic emissions (CEOAEs). The pass/refer rate for a CEOAE-based test was compared to the pass/refer rates for screening criteria based on TBOAE results alone or combined CEOAE and TEOAE results (recorded at 1, 2 and 3 kHz), for data from 298 neonates (546 ears). Using CEOAEs only gave a pass rate of 79.1% and 114 ears were referred. Using CEOAEs, together with TBOAEs recorded at 1 kHz, passed 39 more ears than CEOAEs only and the pass rate was 86.3%. The referral rate thus decreased by 7.2 percentage points. Using TBOAE information at frequencies where CEOAEs were not rated as pass raised the pass rate from 79.1% to 87.6%, lowering the referral rate by 8.5 percentage points. A combined CEOAE and TBOAE protocol may reduce refer outcomes, and hence false-positive rates, in NHS programs.
