Abstract Introduction: Newborn hearing screeners via otoacoustic emissions (OAEs) have become the standard in audiological clinical practice. Despite the application of OAE protocols for more than 3 decades, there has been no consensus on the standardization of the recorded responses. Usually, manufacturers based the scoring criteria of the OAE responses on small scale samples and in many cases on data published in the literature. Since there are no standards in the OAE probe construction, the resulted OAE responses are quite different between OAE screeners. The project evaluated the scoring criteria used in the Interacoustics Sera OAE screener. Methods: Eight hundred and eleven infants were initially screened by the Accuscreen OAE screener for a Pass or a Fail outcome. Seven hundred and ninety-two infants resulted as Pass were re-evaluated with the Sera transient-evoked OAE (TEOAE) and distortion-product OAE (DPOAE) protocols. Results: In terms of screening efficiency, the DPOAE protocol performed better, showing results very similar to the Accuscreen performance (Fail %: 2.4 vs. 2.3). The data showed that the recordings of the TEOAE responses were more prone to noise corruption. Using 10th percentile normative distribution values, DPOAE-optimized scoring criteria were estimated as 3.1, 7.9, 9.9, and 8.9 dB for the tested frequencies of 2.0, 3.0, 4.0, and 5.0 kHz. Unfortunately, the TEOAE signal-to-noise (S/N) data resulted as too noisy (despite relatively large TEOAE responses); therefore, the TEOAE responses were considered as scoring criteria candidates. The latter were estimated as 4.61, 6.35, 7, 1 and 3, 35 dB at 1.4, 2.0, 2.8, 4.0 kHz. Conclusion: It is possible to improve the screening efficiency of the DPOAE Sera protocol using optimized scoring criteria, aiming the correct identification of at least 90% of all normal hearing subjects. The Sera TEOAE protocol needs further investigation to identify the source of the noise, which lowers significantly the reported S/N ratios. The collected OAE data confirm that there are differences among the responses obtained by various screeners; therefore, an OAE probe standardization is necessary.
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