At times you may run into problems with your program that affect such things as your refer rates or the length of time required to screen babies. If your program is not running optimally, review the following troubleshooting guidelines. Your problem may be easily fixed by making simple modifications to your program.

Troubleshooting ABR

Check impedance levels.

If the levels are unacceptably high, scrub the baby's skin again, or try using electrode paste for better contact with the skin.

Make sure that the electrodes are plugged in.

Is the earphone in the ear?

Sometimes the ear canals are so small that it is a challenge to keep the phone in the ear. Also, if the baby moves, the earphone may easily be dislodged. Check the earphone placement often.

Is the earphone clogged?

Often, babies have vernix or earwax in the ear canal. This can clog the earphones, which may affect the stimulus going into the ear. Ensure that the earphone is clear of debris from the baby's ear canal. Also, check the earphone to see if you can hear the stimulus.

Is the baby sleeping quietly?

If the baby is restless or crying, you will not get a good test. The electrodes pick up small impulses from the hearing nerve, but they also pick up muscle movements (artifacts). The baby should be swaddled and sleeping/resting quietly for a good test.

Are there other pieces of medical equipment nearby that may cause electrical interference?

Whenever possible, eliminate extra noise from monitors or other equipment. Check with the nursing staff before touching any medical equipment.

Regular equipment checks and annual calibration will help to ensure that equipment remains in good working order.

Troubleshooting EOAE

Have you chosen the right size probe tip?

Ideally, the largest probe tip that fits into a baby's ear should be used in order to create a good seal. This helps to keep out extraneous environmental noise. A probe tip that is too small will allow too much noise in, which prevents the emissions from being recorded.

Is the probe tip clogged?

Often, babies have vernix or earwax in the ear canal. This can clog the probe tip, which may affect the stimulus going into the ear. Ensure that the probe tip is clear of debris from the baby's ear canal. Also, check the probe tip to see if you can hear the stimulus.

Is the probe tip all the way in the ear?

Often, a baby's ear canal may be collapsed. This can be a problem especially if the baby has just been lying on the ear you are trying to test. To help ensure a good probe fit, gently massage the area in front of the baby's ear in a circular motion for 10 seconds prior to inserting the probe tip. Also, try pulling up and back on the pinna, or outer ear, and massage/rotate gently a few times before inserting the probe. When inserting the probe into the baby's ear, gently pull up and back on the pinna to fully open the ear canal and help obtain a good probe fit.

Give the probe a one-quarter turn as you insert it in the ear, creating a downwards twisting motion. This helps obtain a good fit. A good self-check is to gently tug on the probe once it is in the ear. There should be resistance; if it slides out easily it is too loose.

Are you consistently getting more refer results for the second ear?

Many times the second ear can be more difficult to test because the baby has just been lying on it. Because a newborn's ear canals are soft and sticky, this can easily cause the baby's ear canal to collapse. If you are still having problems screening the second ear after following the suggestions in the above paragraph, try leaving the baby with that ear up, or lying on their back for a while and come back later and try again. This will give that ear a chance to open up and dry out.

Is the baby resting quietly?

Swaddle the baby to keep them from knocking the probe from the ear. An optimal time for testing is just after a baby is fed, and when they have a clean diaper. Excessive movement, sucking, or crying will interfere with the test.

Have you minimized other room noise?

Whenever possible, eliminate extra noise from monitors or other equipment. Check with the nursing staff before touching any medical equipment.

Check for a proper stimulus level.

Regular equipment checks and annual calibration will help to ensure that equipment remains in good working order.

Don't hold the probe while testing

You shouldn't need to hold the probe while testing if you have a good fit. Holding the probe during testing may cause it to touch the wall of the ear canal, preventing the signal from getting through. You can also cause noise that interferes with the testing.

Tips for proper probe fit

Proper probe fit is the key to obtaining a good EOAE screening test, yet many screeners are hesitant when inserting the probe into the baby's ear. A tight seal ensures that your screening test will be quick and accurate. Some tips for obtaining a good probe fit:

  • Select the largest probe tip possible. A probe tip that is too small will allow too much environmental noise in.
  • Give the probe a one-quarter turn as you insert it in the ear, creating a downwards twisting motion. This helps obtain a good fit.
  • Gently tug on the probe once it is in the ear to make sure there is resistance. If it slides out easily, it is too loose.
  • Newborns often have collapsed ear canals. This can especially be problematic if the baby has just been lying on the ear you wish to test. To fully open the ear canal and obtain a good probe fit:
    • Gently massage the area in front of the ear in a circular motion for 10-20 seconds before inserting the probe tip.
    • Gently pull up and back on the pinna, or outer ear, and massage/rotate gently a few times before inserting the probe.
    • When inserting the probe into the ear, pull up and out gently on the pinna to fully open the ear canal.
  • Having the baby swaddled during testing will help to make sure that they don't dislodge the probe during the test.
  • Don't hold the probe during testing. This can cause the probe to touch the wall of the ear canal and prevent a signal from getting through. It can also cause noise that interferes with testing.
  • Make sure your probe tip is clean - sometimes, the probe tip may become clogged by vernix or ear wax. If you need to clean the probe tip, be sure to remove it from the probe prior to cleaning, so you don't inadvertently push the vernix into the probe.

Guidelines for an optimal test environment

  • Quiet room
  • Quiet, sleeping baby
  • Ideally, conduct the test after the baby has been fed
  • Swaddled baby
  • Clean diaper
  • Post a sign to inform others that a hearing test is in progress
  • Complete the test prior to discharge
  • In conjunction with nursing staff, establish test times that are optimal for nurses, parents, and babies' schedules.