Patient guide · Audiology · 5 min read
Otoacoustic emissions (OAE), the objective outer-hair-cell test used in newborn screening and ototoxic monitoring.
Otoacoustic emissions (OAE) test measures cochlear outer-hair-cell function via a probe in the ear canal. Painless and objective — used in newborn hearing screening, ototoxic drug monitoring and paediatric audiology.
Key facts
- 01
Objective outer-hair-cell test
Otoacoustic emissions measure the tiny sounds produced by healthy cochlear outer hair cells in response to stimulation.
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Newborn hearing screening tool
The first-line objective screening test in the NHS Newborn Hearing Screening Programme within days of birth.
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Painless, 2–5 minute test
A soft probe sits in the ear canal — no discomfort, no needles, no radiation, and no active response required from the patient.
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Complements ABR and audiometry
OAE checks cochlear function; ABR checks the auditory nerve pathway; audiometry checks perceived hearing. Together they localise the loss.
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Ototoxic drug monitoring
Detects early cochlear damage from aminoglycoside antibiotics and platinum-based chemotherapy before hearing loss becomes noticeable.
- 06
Detects mild–moderate cochlear loss
Sensitive to sensorineural hearing loss of roughly 25–30 dB or greater at the tested frequencies.
How it’s done
From consultation to written report — what happens, in order.
One appointment, one audiologist, one clear plan — the whole test is usually finished within half an hour.
- 01
Before
Consultation and history
A short conversation about symptoms, birth history, family hearing loss, ototoxic exposure and any relevant ENT background.
- 02
On the day
Small probe placed in ear canal
A soft-tipped probe with a microphone and speaker is gently seated in the outer ear. No pain, no preparation.
- 03
On the day
Click or tone stimuli delivered
The probe emits brief clicks (transient-evoked OAEs) or paired tones (distortion-product OAEs) into the ear canal.
- 04
On the day
Emissions recorded
The microphone captures the faint acoustic response from healthy outer hair cells — usually within a minute or two per ear.
- 05
On the day
Pass / refer result generated
The device compares the response to reference criteria and returns a pass, or a refer flag that triggers a repeat or onward test.
- 06
On the day
Repeat with different frequencies
The stimulus is repeated across frequency bands (typically 1–5 kHz) to build a fuller cochlear picture.
- 07
After
Written report and plan
A short written report with the audiologist’s interpretation and clear next steps — rescreen, ABR, ENT review or reassurance.
Typical appointment: 20–30 minutes. Test itself: 2–5 minutes per ear.
What it shows
When an OAE test is the right test.
OAE answers a specific question — are the cochlear outer hair cells responding — and it does that better than any subjective test. These are the presentations it addresses.
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Present OAEs
Normal outer-hair-cell function at the tested frequencies — the cochlea is responding as expected.
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Absent OAEs
Suggests cochlear sensorineural hearing loss, most often at or above 25–30 dB in the tested band.
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Newborn screening pass / refer
The first objective check in the NHS Newborn Hearing Screening Programme, typically in the first weeks of life.
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Auditory neuropathy screen
Present OAEs alongside an absent ABR flags auditory neuropathy spectrum disorder for urgent paediatric review.
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Ototoxic monitoring
Serial OAEs pick up early cochlear injury from aminoglycosides or platinum chemotherapy before symptoms.
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Paediatric hearing loss
An objective assessment for children too young to co-operate with pure-tone audiometry.
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Middle-ear effusion
Absent OAEs with a flat tympanogram point to fluid in the middle ear rather than cochlear loss.
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Red flag: absent OAEs plus failed rescreen — urgent paediatric ABR
A failed rescreen in an infant needs a fast-track diagnostic ABR to confirm and grade hearing loss.
Next steps and management
What follows an OAE test result.
The plan after an OAE test depends on the result and the clinical picture — reassurance, a rescreen, or a fast-track diagnostic pathway.
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Reassurance for present OAEs
A clean pass at all frequencies is reassuring for cochlear outer-hair-cell function and rarely needs further imaging.
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Repeat OAE at 4–6 weeks
Borderline or single-ear refers are commonly repeated after a short interval to exclude debris, effusion or state effects.
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Paediatric ABR for failed rescreen
Infants who fail a rescreen are referred for a diagnostic auditory brainstem response to confirm and quantify hearing loss.
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Hearing-aid trial for confirmed loss
Once loss is confirmed and graded, an amplification trial is arranged with a paediatric or adult audiologist as appropriate.
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Cochlear implant assessment
For severe-to-profound sensorineural loss, referral to a specialist cochlear implant centre for candidacy assessment.
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Ototoxic drug monitoring
Structured serial OAE testing during and after treatment with aminoglycosides or platinum-based chemotherapy.
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ENT referral for effusion
Persistent middle-ear effusion causing absent OAEs is managed by ENT — watchful waiting, hearing aids or grommets.
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Structured audiology follow-up
A tailored recall schedule when risk factors, family history or ototoxic exposure warrant longer-term surveillance.
Red flags
When an OAE result needs an urgent onward pathway.
These are the clinical situations where a refer, an absent response, or a mismatched pattern needs prompt specialist input — not the next routine screen.
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Neonatal absent OAE + high-risk factors
NICU stay, low birth weight, hyperbilirubinaemia or family history of childhood hearing loss — expedite diagnostic ABR.
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Sudden SNHL
Sudden sensorineural hearing loss is an ENT emergency — same-day audiology and ENT review, not a routine slot.
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Auditory neuropathy spectrum
Present OAEs with absent or grossly abnormal ABR — urgent paediatric audiology and ENT input.
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Chemo-induced ototoxicity
Platinum agents (cisplatin, carboplatin) cause dose-dependent cochlear damage — serial OAE monitoring is standard.
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Aminoglycoside ototoxicity
Gentamicin, tobramycin and amikacin can cause irreversible cochlear injury — monitor OAEs during prolonged courses.
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Post-meningitis hearing loss
Bacterial meningitis can cause rapid-onset sensorineural loss and cochlear ossification — audiology within weeks, not months.
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Genetic hearing loss
Family history of connexin 26 or syndromic hearing loss warrants early objective testing and genetic counselling.
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Delayed speech in children
A child not meeting speech milestones needs objective hearing assessment — do not wait for the next screen.
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Post-otitis media persistent effusion
Effusion lasting beyond three months affects OAE recording and hearing — ENT referral for structured management.
Sources and clinical review
The guidance behind this guide. Clinically reviewed.
Last reviewed 2026-07-30 by Pulse Atlas Editorial Board (). Next review 2027-07-30.
A quiet reminder
This is a patient guide, not medical advice.
If you have concerns about your hearing or your child’s hearing, speak to your GP or an audiologist for an individual assessment.
- 01 Source
British Society of Audiology. Recommended procedures for otoacoustic emissions testing.
British Society of Audiology. Recommended procedures for otoacoustic emissions testing. - 02 Source
NHS Newborn Hearing Screening Programme. Standards and guidance.
NHS Newborn Hearing Screening Programme. Standards and guidance. - 03 Source
American Speech-Language-Hearing Association. Otoacoustic emissions clinical guidance.
American Speech-Language-Hearing Association. Otoacoustic emissions clinical guidance. - 04 Source
Joint Committee on Infant Hearing. Year 2019 Position Statement.
Joint Committee on Infant Hearing. Year 2019 Position Statement.
Frequently asked
Everything patients ask about the OAE test.
Quick answers on what OAE measures, how it differs from ABR, why it is used for newborns, and what a refer result actually means.
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What does an otoacoustic emissions (OAE) test show?
It measures the tiny sounds produced by healthy outer hair cells in the cochlea when stimulated. A clear response means those cells are working; an absent response suggests cochlear hearing loss, middle-ear fluid, or debris in the ear canal — and prompts a repeat test or an auditory brainstem response.
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Is the OAE test painful?
No. A soft-tipped probe sits in the outer ear canal for a few minutes. There are no needles, no radiation and no active response required — babies commonly sleep through it.
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How long does an OAE test take?
Around 2–5 minutes per ear once the child or adult is settled. The whole appointment, including history and explanation, is typically 20–30 minutes.
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How is OAE different from an ABR test?
OAE checks cochlear outer-hair-cell function; ABR (auditory brainstem response) checks the auditory nerve and brainstem pathway. Present OAEs with an absent ABR is the classic pattern for auditory neuropathy spectrum disorder.
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Why is OAE used in newborn hearing screening?
It is quick, objective, painless and does not need the baby to co-operate. That combination makes it the ideal first-line test within the NHS Newborn Hearing Screening Programme.
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My baby failed the newborn hearing screen — what happens next?
A refer result is not a diagnosis. It triggers a repeat OAE and, if that also refers, a diagnostic auditory brainstem response with a paediatric audiologist to confirm whether hearing loss is present and grade it.
Related tests
Looking for a different test?
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Auditory brainstem response
Objective test of the auditory nerve and brainstem pathway — the diagnostic follow-on to a failed OAE.
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Hearing loss assessment
A full audiology work-up combining audiometry, tympanometry and objective tests.
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Tympanometry
Middle-ear function test that pairs with OAE to separate cochlear from conductive causes.
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In practice, in London
Getting otoacoustic emissions test sorted in London, without the guesswork
With otoacoustic emissions test, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Waiting lists on the NHS for otoacoustic emissions test vary widely by borough and by how the GP letter reads. Privately in London, we can normally offer a slot inside the same week, sometimes within 48 hours if there’s a cancellation. The difference isn’t clinical quality — the consultants are frequently the same faces you’d see on the NHS — it’s the calendar.
A typical private booking for otoacoustic emissions test in London starts with a consultant conversation — sometimes in person on Harley Street or Marylebone, sometimes on video if that suits better. Any imaging or diagnostics happen at a nearby CQC-registered facility, and reports usually land within 24 to 72 hours. The whole loop, from first call to written report, is often done inside a fortnight. For otoacoustic emissions test specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Fit matters more than people expect. For otoacoustic emissions test, the right consultant depends on what you actually need — a second opinion, a definitive diagnosis, a bridge into treatment, or reassurance that nothing’s being missed. We match on that, not on who has the biggest brochure. If a test isn’t the right next step, we’ll say so before you book anything.