Preschool Hearing Screening – Could Otoacoustic Emission (OAE) screening provide an effective, efficient and well-tolerated alternative to Pure Tone audiometry?

Dr Emma Williams1,2

 1Ministry of Health, Thorndon, New Zealand,

 2Paediatric Department – Wellington Hospital, Newtown, New Zealand


In New Zealand children aged 4 years have preschool hearing screening at the B4 School Check using pure tone audiometry (PT).

Pure tone audiometry remains the gold standard in this age group, however the limitations of this method include time required, developmental level necessary and subjectivity of outcome. In New Zealand rescreen rates are high, partially due to many children being unable to understand or unwilling to comply with pure tone testing. OAE screening has been suggested as a quicker, objective and development-independent alternative, that may reduce rescreen rates..

Our study investigated whether an OAE screen could be used as an alternative screening method in the B4 school check setting.



Pass/refer outcomes are similar between PT and OAE Fewer children are ‘unable’ to be screened using OAE OAE screening is quicker than PT



155 children aged 4 to 4 years 11 months were enrolled in the Wellington region at their B4 school check.

All children had PT first as per the current NZ hearing screening protocol and then an OAE. The outcomes of both screens and the time taken was recorded.

A DPOAE screen was used at 2, 3, 4, 5kHz with a pass criteria of 4/4 frequencies. DP minimum amplitude was 0dB and SNR 6.



OAE screening was a feasible screening method for this age group in the community setting.

Successful OAE screening was dependent on screener experience, device used and pass/refer criteria.


Further information about the results obtained and their implications for developing a preschool hearing screening protocol will be discussed in the presentation.


Emma is an advanced trainee paediatric registrar working in Wellington New Zealand. Emma completed this research during a placement at the Ministry of Health, New Zealand. Emma trained in medicine at Cambridge and University College London.