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Audiology

Otoacoustic Emissions

Otoacoustic emissions testing offers another modality of evaluation of the auditory system beyond conventional audiometry. It may be performed for patients with suspected hearing loss who cannot tolerate or complete conventional hearing tests. The testing does not require recording a patient's subjective response to sound. There are several different ways to measure otoacoustic emissions, each with advantages and disadvantages. This activity reviews the evaluation of hearing loss using otoacoust

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Children screening positive for hearing loss should be immediately referred for a formal hearing evaluation, genetic testing, and hearing augmentation with hearing aids, cochlear implants, and/or speech rehabilitation to promote long-term speech and language outcomes.
  • The cochlear amplifier is lost in patients with sensorineural hearing loss, resulting in poor speech discrimination.
  • Auditory neuropathy spectrum disorder is one of the most common retrocochlear pathologies evaluated by OAE.
  • Otoacoustic emissions testing offers another modality of evaluation of the auditory system beyond conventional audiometry.
  • It may be performed for patients with suspected hearing loss who cannot tolerate or complete conventional hearing tests.
  • The testing does not require recording a patient's subjective response to sound.
  • Otoacoustic emissions (OAE) are sounds generated from the cochlea and transmitted across the middle ear to the external ear canal, where they can be recorded.
  • The production of an OAE is a marker for inner ear health and a simple way to screen for hearing loss.
  • Transient evoked and distortion-product OAEs are the most commonly used techniques for newborn hearing screening.
  • OAEs are also very sensitive in detecting mild hearing impairment.
  • Damage to the outer hair cells from noise trauma or ototoxic medications can be detected on OAE before it appears on an audiogram.
Ototoxicity Monitoring Threshold
Changes of 2.4 dB or more are considered a significant decrease and indicate a change in cochlear function.
  • The universal newborn hearing screening program includes OAE and auditory brainstem response (ABR) testing.
  • Prior to starting ototoxic medications, patients should undergo baseline OAE testing and repeat testing with each dose.
  • OAE may not be measurable in children with adhesive otitis, even when outer hair cells are healthy.
  • Thus, OAE cannot distinguish between conductive and sensorineural hearing loss.
  • There is a risk of false positives due to contamination from other sounds, either from the test environment or internal sounds such as breathing and swallowing.
  • Since OAEs travel through the middle ear, they can also be affected by any middle ear disease, such as middle ear effusion.
  • OAE has been increasingly used to monitor the ototoxicity of medications, particularly aminoglycoside antibiotics and platinum-based chemotherapy agents.
  • Its quick application and cost efficiency make it a good clinical choice to follow patients during their therapeutic course.
  • The pediatrician should perform long-term monitoring of childhood development with regular follow-up with audiology for routine hearing aid and audiogram assessments.
  • OAE may also disappear over time in patients with auditory neuropathy spectrum disorder.
  • review
    Otoacoustic Emissions. StatPearls [Internet] — Allen Young, Matthew Ng — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov