title: Otoacoustic emissions in newborn hearing screening: a systematic review of the effects of different protocols on test outcomes.
abstract: OBJECTIVE
  Otoacoustic emission (OAE) tests are currently used to screen newborns for congenital hearing loss in many Universal Newborn Hearing Screening programs. However, there are concerns about high referral and false-positive rates. Various protocols have been used to address this problem. The main objective of this review is to determine the effects of different screening protocols on the referral rates and positive predictive values (PPV) of the OAE newborn screening test.
  
  
  METHODS
  Eligible studies published in English from January 1990 until August 2012 were identified through searches of MEDLINE, Medline In-Process, Embase, PubMed (NCBI), ISI Web of Science, and the Cochrane Central Register of clinical controlled trials. Two reviewers independently screened the data sources, using pre-defined inclusion criteria to generate a list of eligible articles. Data extracted included the number of newborns screened, age at screening, OAE pass criteria, frequencies screened, number of retests, referral rates, and the number of newborns identified with permanent congenital hearing loss.
  
  
  RESULTS
  Ten articles met the inclusion criteria, with a total of 119,714 newborn participants. The pooled referral rate was 5.5%. Individual referral rates ranged from 1.3% to 39%; the PPV from 2 to 40%. Increasing the age at initial screening and performing retests reduced the referral rate. Likewise, screenings involving higher frequencies had lower referral rates.
  
  
  CONCLUSIONS
  Delaying newborn hearing screening improves test results but may not be practical in all contexts. The use of higher frequencies and more sophisticated OAE devices may be useful approaches to ensure better performance of the OAE test in newborn hearing screening.
authors.affiliation: McGill Auditory Sciences Laboratory, McGill University, Montréal, QC, Canada.
authors.forename: Olubunmi V
authors.initials: OV
authors.lastname: Akinpelu
authors.affiliation: McGill Auditory Sciences Laboratory, McGill University, Montréal, QC, Canada.
authors.forename: Emilia
authors.initials: E
authors.lastname: Peleva
authors.affiliation: McGill Auditory Sciences Laboratory, McGill University, Montréal, QC, Canada; Department of BioMedical Engineering, McGill University, Montréal, QC, Canada; Department of Otolaryngology - Head and Neck Surgery, McGill University, Montréal, QC, Canada.
authors.forename: W Robert J
authors.initials: WR
authors.lastname: Funnell
authors.affiliation: McGill Auditory Sciences Laboratory, McGill University, Montréal, QC, Canada; Department of Otolaryngology - Head and Neck Surgery, McGill University, Montréal, QC, Canada. Electronic address: sam.daniel@mcgill.ca.
authors.forename: Sam J
authors.initials: SJ
authors.lastname: Daniel
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D005189:False Positive Reactions; D034381:Hearing Loss / Q000151:congenital / Q000175:diagnosis / Q000453:epidemiology; D006320:Hearing Tests / Q000379:methods; D015997:Neonatal Screening / Q000379:methods; D017084:Otoacoustic Emissions, Spontaneous / Q000502:physiology; D015995:Prevalence; D011792:Quebec; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D002985:Clinical Protocols
keywords: False positives; Hearing screening; Newborn; Otoacoustic emissions; Referral rates; Review [publication type]