Information for Hearing Screening Professionals

Screening Techniques, Equipment and Protocols

The selection of your screening equipment and your screening protocol are highly dependent on each other. The protocol you select influences what equipment you select, and the equipment you select will influence your protocol.

You should read all of the information in this section before proceeding in the selection of your equipment and/or protocol.

Comparison of EOAE and ABR Testing – Which is better?

When choosing which type of test to use, you should keep in mind that both tests are noninvasive, neither test is perfect but both perform essentially equally well, and both tests may miss some mild hearing loss.

Your decision of test type should be based on the following:

  • Cost of equipment
  • Cost of disposable supplies for each baby tested
  • Amount of training required for screeners
  • Amount of time needed to complete the test
  • Degree of hearing loss to be detected and flexibility of use
  • Likelihood of patients to return for a follow-up 

See a comparison chart of EOAE and ABR (PDF).

Selecting Equipment

When choosing your equipment, don't let a manufacturer talk you into believing that their equipment is better than the rest.

All equipment that is currently on the market is good, and the piece of equipment that is best for you depends on the features that suit your newborn hearing screening program best.

When choosing your equipment, you should consider the following:

  • Cost of both the equipment and the disposables
  • What kind of screening test it performs (EOAE, ABR or both?)
  • Data storage capacity
  • Ease of use
  • Portability
  • Warranties
  • Availability and quality of customer service (what if you have an equipment breakdown?)
  • Is there a neonatal intensive care unit (NICU)? According to the Joint Committee on Infant Hearing 2007 Position Statement, separate protocols are recommended for NICU and well-infant nurseries, and NICU infants admitted for more than 5 days are to have ABR included as part of their screening so that neural hearing loss will not be missed.

Questions you have about a specific piece of equipment can be answered by the equipment manufacturer representative or a local equipment distributor.

Selecting Your Screening Protocol

There are many screening protocols to choose from. Keep in mind the following points when designing a protocol for your newborn hearing screening program:

  • Inpatient screening and not outpatient screening is the best way to ensure that your program screens all newborns for hearing loss.
  • Including a re-screening in your protocol helps ensure a low refer rate to diagnostic audiology.
  • One-stage and two-stage programs are both acceptable. Which one you choose will depend on the needs and resources of your program.
  • The screening is best performed close to discharge, and when the baby is quiet and sleeping.
  • Viewing some sample protocols can help you select one that is most effective for your program.

Inpatient screening vs. outpatient screening

The goal of a newborn hearing screening program is to provide universal newborn hearing screening, screening at least 95% of infants born at your facility. With return rates for outpatient appointments less than optimal, an outpatient program will most often not be a universal program.

Congenital hearing loss occurs in approximately 3 in 1,000 newborns (the most frequently occurring birth defect). A low rate of return to outpatient visits could mean that babies with hearing loss are missed.

A well-designed program, consisting of thorough training for the screeners, minimizes the impact on existing staff and financial resources. The majority of hospitals that have successfully implemented inpatient universal newborn hearing screening programs comment how simple it is, how little time it takes, and the positive impact it has on the families they serve.

Including re-screening in your protocol

To keep your refer rates low, it is recommended that your protocol includes a follow-up re-screening for babies who do not pass the initial hearing screening. It is best if the re-screening occurs on an outpatient basis.

This gives some time for the infant's ears to clear of any possible vernix or fluid. If it is not possible to include outpatient re-screening in your protocol, the re-screening can be performed prior to discharge, though it is not usually preferable.

The re-screening should occur prior to one month of age. It can be done using the same equipment as the initial screening, or with different equipment.

Most babies pass the second screening.

One-stage vs. two-stage screening

One-stage screening means that only one test type is used. It can be either EOAE or ABR.

Two-stage screening means that both test types (EOAE and ABR) are used. Usually EOAE is done first because:

  • EOAE is usually faster to perform.
  • EOAE is usually less expensive to perform.

Whether you choose to use one-stage or two-stage screening will depend on your patient population, how much money you have to spend on screening equipment and how your program is staffed.

Please note: for two-stage screenings, the order of equipment used first matters, according to the Joint Committee on Infant Hearing. Please use these guidelines:

  • If the initial test used an OAE, rescreen with Otoacoustic Emissions (EOAE, OAE, TEOAE, DPOAE), Auditory Brainstem Response (ABR, AABR, BAER, ABAER) or a combination of both measures.
  • If the initial test used ABR, rescreen with only ABR to avoid missing a neural hearing loss.

When is the best time to perform the hearing screenings?

It is best to perform the hearing screenings as close to discharge as possible to allow the infants ears to clear of any fluid and birthing debris.

Although a screening can be done as little as 6 hours after birth, it is recommended that you wait until at least 12 hours after birth whenever possible to help ensure lower refer rates.

The screening should be done when the baby is quiet and sleeping.

Ideally the screening should be done to allow enough time for a second attempt prior to discharge if needed.

Enough time should be allowed to inform the parents of the screening results in a calm manner with plenty of time for questions before discharge.

Sample Protocols

There are many screening protocols that can be used effectively. Which protocol you choose depends on factors such as:

  • Likelihood of patients to return for follow-up
  • Diagnostic audiologic services (PDF) available in your area (how far do families have to travel for a diagnostic hearing evaluation?)
  • Staffing availability
  • What equipment you have

Variations on the following protocols can be tailored to fit your individual hospital's needs. All files are PDFs.