A neonate spent three weeks in the NICU for hyperbilirubinemia requiring exchange transfusion. Which hearing screening modality is preferred for this baby rather than otoacoustic emissions alone?

• A Tuning fork tests at discharge
• B Distortion product otoacoustic emissions alone
• C Behavioral observation audiometry
• D Automated auditory brainstem response (AABR) ✓

Explanation

NICU graduates are at risk for auditory neuropathy spectrum disorder, in which outer hair cells are intact so otoacoustic emissions pass despite absent neural conduction. Hyperbilirubinemia, prematurity and hypoxia damage the inner hair cells or auditory nerve while sparing outer hair cells. Only AABR, which assesses neural synchrony through the brainstem pathway, will detect this condition, so OAE alone gives a false sense of security.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.