Does a TEOAE refer / AABR pass profile at the neonatal hearing screening indicate risk?

To evaluate the long-term outcomes of infants with a "refer" result on transient evoked otoacoustic emissions (TEOAE) but a subsequent bilateral "pass" on the automated auditory brainstem response (AABR) at neonatal screening, with the goal of determining the risk of permanent hearing loss and potential functional consequences during childhood of this profile.

We retrospectively analyzed infants born between 2011 and 2019 at Pisa University Hospital (Italy) who failed TEOAE but passed bilateral AABR. Long-term follow-up was conducted ≥5 years after screening using a structured telephone questionnaire on functional outcomes (speech therapy, language delay, school difficulties, formal diagnosis of hearing loss). Children with positive responses were recalled for in-person audiological testing.

Among 16,574 screened newborns, 74 (0.45 %) showed a TEOAE "refer" but bilateral AABR "pass". Long-term data were obtained for 63 children (85.1 %), with a mean follow-up age of 9.2 years (median 10, range 5-12). Of the 25 children who reported at least one functional difficulty and underwent in-person audiological reassessment, three (4.7 % of the total cohort) showed conductive hearing loss, while all others had normal pure-tone thresholds (≤20 dB HL bilaterally). The conductive losses were associated with otitis media with effusion and underlying conditions such as Down syndrome or cleft palate. Despite these findings, 25 children (39.7 %) were reported to have functional difficulties, including need for speech therapy, language delay, or school problems.

This is the first study to report long-term (>5 years) outcomes in children with a TEOAE "refer"/bilateral AABR "pass" profile. In this cohort, no cases of permanent hearing loss were identified. However, the relatively high prevalence of functional difficulties highlights the importance of pediatric surveillance to ensure timely recognition of developmental issues.