An otoacoustic emission (OAE) test is performed on a 3-day-old neonate and is absent bilaterally. What does absent OAE indicate and what is the NEXT appropriate investigation?

• A Confirms bilateral profound deafness; proceed to cochlear implant evaluation
• B Indicates absent cochlear hair cell function; no further testing needed if parents report normal reactions to sound
• C Indicates VIII nerve pathology; MRI brain is indicated
• D Suggests possible hearing loss or middle ear fluid; follow-up with automated ABR (AABR) for threshold estimation ✓

Explanation

OAE (otoacoustic emissions) reflect outer hair cell function and are used as a first-tier newborn hearing screening test. Absent OAE indicates either outer hair cell dysfunction OR conductive pathology (e.g., vernix/middle ear fluid in neonates, which is very common). A refer result on OAE does not confirm deafness and requires second-tier testing with automated ABR (AABR), which tests neural synchrony. This is the two-stage newborn hearing screening protocol. If AABR is also absent, formal diagnostic ABR follows. MRI is not the next step.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.