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PHILIPPINE ACADEMY OF NEUROTOLOGY, OTOLOGY & RELATED SCIENCES A Study Group of the Philippine Society of Otolaryngology-Head & Neck Surgery NEWBORN HEARING SCREENING OTOACOUSTIC EMISSION REPORT Name of Patient Date of Birth Mothers Name Home Address Attending Physician Case No Gender Contact No ( ) In-Patient ( )Out-Patient RESULTS RIGHT EAR LEFT EAR PASS PASS REFER REFER IMPRESSION PASS (OAE detected) An Otoacoustic Emission (OAE) test was performed on your child. A “PASS” means that a normal response was recorded from your child’s ears. This response is consistent with a normal peripheral hearing levels. No further testing is recommended at this time. However, continuous monitoring of your child’s hearing and speech development should be conducted throughout the first few years of life. REFER (OAE not detected) An Otoacoustic Emission (OAE) test was performed on your child. A “REFER” means that a normal response could not be recorded from one or both of your child’s ears. This could be due to a high noise level in the nursery/room, an active baby or vernix/wax in the ear canal at the time of test or presence of hearing loss. Your child should be re-tested within three months. RECOMMENDATION No further testing is required at this time, retest only if hearing loss is suspected. (Patient did not pass audiologic screening.) Follow-up audiologic testing within 3 months. Suggest a more diagnostic test, e.g. auditory brainstem response (ABR). Suggest ENT referral for ear/otoscopic evaluation. Date of Test __________________ Audiometrist __________________