External and middle ear status related to evoked otoacoustic emission in neonates

• Objective. —Screening auditory status prior to neonatal hospital discharge to identify newborns with severe hearing impairment is an important pediatric care priority. Evoked otoacoustic emission (OAE) testing is a quick noninvasive method. The purpose of this study was to determine the relationship between external auditory canal and middle ear status with click-evoked OAE. It was hypothesized that vernix caseosa, debris in the ear canal, and middle ear fluid contribute to the OAE fail rate. Design. —All neonates had an initial OAE examination. A second investigator, "blinded" to the results, examined all ears otoscopically, cleaned any obstructing debris, and repeated with a second OAE test. Setting. —All neonates were tested in a designated nursery at a mean age of 43±21 hours. Patients. —Forty-one full-term neonates were prospectively enrolled. Intervention. —The ear canals with debris were cleaned under direct vision with a pediatric swab dampened by an alcohol wipe. Outcome Measure —The primary outcome measure was the postcleaning OAE pass rate. Results. —The preotoscopic examination pass rate of 82 ears was 76%. The OAE pass rate improved to 91% after debris removal. Conclusions. —The results indicate that the examination and cleaning of the external ear canal are important components of the neonatal screening process. (Arch Otolaryngol Head Neck Surg.1993;119:276-282)