OAE Screening Had Higher Preschool Completion Than Audiometry

Otoacoustic emission (OAE) screening was completed more often than pure-tone audiometry (PTA) among preschool-aged children, with smaller age- and language-related differences, according to a prospective cohort study published in JAMA Network Open. OAE was completed in both ears for 6745 of 7035 children (95.9%), compared with 4601 (65.4%) for PTA (P<.001).

The analysis used data from a randomized trial of community hearing screening and was conducted at 204 preschools in 15 California counties from November 2023 through December 2025. All children attempted both screening modalities in randomized order, permitting within-participant comparisons. Completion rates did not differ according to which test was attempted first.

Completion increased with age for both modalities, although OAE completion exceeded 90% in every age category. Among children younger than 3 years, 21.2% completed PTA and 90.5% completed OAE. Among children aged 3 to 4 years, the respective completion rates were 62.6% and 96.1%.

In adjusted analyses among Spanish-speaking children, estimated PTA completion was 0.75 with screeners who had high Spanish proficiency and 0.60 with those who had low proficiency. High-proficiency screeners achieved similar PTA completion among Spanish- and English-speaking children (ratio of estimated probabilities, 0.96; 95% CI, 0.91-1.02). With low-proficiency screeners, completion was lower among Spanish-speaking children (ratio, 0.87; 95% CI, 0.80-0.94). Estimated OAE completion among Spanish-speaking children was 0.98 in both screener-proficiency groups.

Investigators said the findings suggest that OAE may offer a more equitable single-modality screening option, but completion alone does not establish comparative screening effectiveness. Limitations included the inability to compare covariate associations directly between modalities, subjective classification of screener Spanish proficiency, exclusion of bilingual English- and Spanish-speaking children from the language analysis, and assessment of language concordance only for English and Spanish. OAE also does not evaluate the entire auditory pathway and may leave mild hearing loss undetected. Results can be affected by middle-ear effusions, cerumen, motion artifact, screener training, and probe location.

Source: Kaufman L, Stephans J, Lee M, Giammona JB, Chan DK. Completion rates of screening examinations for hearing among preschool-aged children. JAMA Netw Open. 2026;9(8):e2630641. doi:10.1001/jamanetworkopen.2026.30641