Accuracy of OAE as a Screening Test to Detect the Incidence of Hearing Loss in Normal and High-Risk New-borns

Abstract

Background: Hearing loss is one of the most common congenital sensory impairments and remains an important public health concern due to its long-term impact on speech, language, and cognitive development. Early identification through universal newborn hearing screening enables timely intervention and significantly improves developmental outcomes. Otoacoustic emissions (OAE) are widely used for initial screening, while Auditory Brainstem Evoked Response (BERA) serves as the diagnostic gold standard. However, the diagnostic performance of single-stage versus repeat OAE screening in comparison with BERA requires further evaluation, particularly in high-risk new-borns. Objectives: To assess the diagnostic accuracy of initial and repeat OAE screening compared with BERA, to determine the incidence of hearing loss among normal and high-risk new-borns, and to evaluate the association between selected perinatal risk factors and confirmed hearing loss. Methods: A prospective diagnostic accuracy study was conducted among 376 new-borns at a tertiary care hospital, CIMS, Chamarajanagar. All enrolled neonates underwent initial OAE screening within 7^th to 10^th day of birth, followed by repeat OAE after 1^st month of first OAE. If both OAE results were refer, then confirmatory BERA done at 6months as the reference standard for confirmation of hearing loss. Demographic and perinatal risk factors were recorded. Diagnostic parameters including sensitivity, specificity, predictive values, likelihood ratios, diagnostic accuracy, and Cohen’s kappa were calculated. Associations between hearing loss and risk factors were analyzed using Chi-square or Fisher’s exact test. Results: The overall incidence of confirmed hearing loss was 4.26%, with a significantly higher prevalence among high-risk new-borns compared to normal-risk neonates (5.9% vs. 1.44%, p = 0.038). Initial OAE demonstrated a sensitivity of 56.25% and specificity of 96.39%, while repeat OAE showed improved sensitivity (81.25%) and specificity (97.50%). Diagnostic accuracy increased from 94.68% to 96.81%, with better agreement with BERA (kappa 0.67). Family history of hearing loss was significantly associated with confirmed hearing impairment. Conclusion: A two-stage OAE screening protocol followed by confirmatory BERA improves detection of neonatal hearing loss and is particularly effective in high-risk new-borns. Integration of repeat OAE into universal new-born hearing screening programs is recommended for early diagnosis and intervention.

Keywords: New-born hearing screening; Otoacoustic emissions; BERA; Diagnostic accuracy; High-risk neonates; Universal screening