Hearing Tests and Evaluations

What Is Otoacoustic Emissions Testing?

Learn how otoacoustic emissions testing checks cochlear outer-hair-cell function, what present or absent OAEs may mean, and how OAE differs from a hearing test.

Audiology.md Editorial TeamEditorial and medical review pendingDraft reviewed September 7, 2026About 10 min read

By Audiology.md Editorial Team

Editorial oversight by Bencasso, Founder & Editor-in-Chief

Audiologist gently positioning an otoacoustic emissions probe at an adult patient's ear in a calm hearing clinic. — Otoacoustic emissions testing uses a small ear-canal probe to measure a faint response generated by the cochlea.

This article provides general education and does not diagnose or treat any person. Sudden hearing loss requires immediate professional medical evaluation.

Sudden hearing loss requires urgent medical assessment.

If hearing drops suddenly in one or both ears—over hours or a few days—seek urgent care. Do not wait for a routine OAE appointment or rely on a screening result. Severe ear pain, drainage, bleeding, significant dizziness, facial weakness, or symptoms after a head or ear injury also warrant prompt medical guidance.

Otoacoustic emissions testing—usually shortened to **OAE testing**—is an objective way to check the function of sensory cells in the cochlea, the hearing organ of the inner ear. A small probe placed in the ear canal presents soft sounds and measures a faint response that the cochlea can produce. The person being tested does not press a button or repeat words. The equipment listens for the response through a sensitive microphone in the probe. This makes OAE testing useful for newborn hearing screening, children who cannot yet complete a conventional hearing test, and adults whose evaluation needs additional physiologic information. An OAE result is not a complete hearing test and is not a diagnosis by itself. A present response provides evidence that certain cochlear outer hair cells are functioning under the test conditions. An absent or reduced response has several possible explanations, including earwax, middle-ear dysfunction, background noise, probe fit, or cochlear hearing loss. An audiologist interprets the result with the ear examination, tympanometry, behavioral hearing thresholds, and other tests.

What are otoacoustic emissions?

The cochlea is a fluid-filled structure in the inner ear. Inside it are specialized sensory cells called hair cells. Outer hair cells help sharpen and amplify the cochlea's response to sound. Their activity can produce extremely soft acoustic energy that travels backward from the cochlea, through the middle ear, and into the ear canal. These faint sounds are called **otoacoustic emissions**. They are not sounds a person normally notices. A sensitive microphone can record them when test conditions are quiet and the pathway through the outer and middle ear is suitable. OAEs provide information about cochlear function—particularly outer-hair-cell activity. They do not show how the auditory nerve and brain process sound, and they do not directly tell the clinician the softest sounds a person consciously hears.

What does an OAE test measure?

OAE equipment compares the sounds delivered into the ear with the acoustic response recorded by the probe microphone. The system analyzes the response by frequency and determines whether it is sufficiently above the surrounding noise to meet the test criteria. Depending on the equipment and purpose, the report may include: - Whether a response is present or not detected - The strength or level of the emission - The background or noise floor during the measurement - The signal-to-noise relationship - Results at individual frequencies or frequency bands - Probe-fit or test-quality information - An automated “pass” or “refer” screening outcome Clinical interpretation is more than reading a pass/fail label. The audiologist considers response size, reproducibility, noise, test frequencies, age, middle-ear findings, hearing thresholds, and the reason for testing.

What happens during OAE testing?

The clinician usually examines the ear canal and eardrum before beginning. Earwax, drainage, debris, or a middle-ear problem can affect the measurement and may need to be addressed or documented. During the test: 1. A small, soft probe tip is placed at the entrance of the ear canal. 2. The probe presents a series of clicks or tones. 3. A sensitive microphone records the sound returning from the ear. 4. The equipment separates the possible cochlear response from background noise. 5. The clinician checks the recording quality and may repeat the test or reposition the probe. You do not need to respond to the sounds. You will be asked to remain quiet and still. Talking, moving, chewing, swallowing, crying, or environmental noise can make the faint emissions harder to measure.

Does OAE testing hurt?

OAE testing is generally painless and noninvasive. The test sounds are usually soft to moderate, and the probe rests in the ear canal without changing air pressure. Most people notice only the feeling of the probe tip and the test sounds. Tell the clinician if placement is uncomfortable or painful. Also mention ear pain, drainage, recent ear surgery, a known eardrum perforation, pressure-equalization tubes, or significant sound sensitivity before testing. The clinician can determine whether the test is appropriate and adjust the procedure if needed.

How long does an OAE test take?

A clean recording may take only a few minutes for both ears. Testing can take longer if the person is moving, the room is noisy, the probe does not seal well, or the clinician needs to repeat specific frequencies. Newborns are often screened while sleeping or resting quietly. Older children may sit on a caregiver's lap. Adults are usually asked to sit still and avoid speaking while each ear is measured.

Types of otoacoustic emissions

Several kinds of OAEs can be measured. The most common clinical tests are transient-evoked and distortion-product otoacoustic emissions. ### Transient-evoked otoacoustic emissions **Transient-evoked otoacoustic emissions**, or **TEOAEs**, are usually elicited with brief sounds such as clicks or chirps. The equipment averages multiple recordings and evaluates the response across a range of frequencies. TEOAEs are frequently used in screening and diagnostic cross-checking. The frequencies and pass criteria depend on the equipment and clinical protocol. ### Distortion-product otoacoustic emissions **Distortion-product otoacoustic emissions**, or **DPOAEs**, are elicited by presenting two tones at the same time. The cochlea's nonlinear response can produce energy at additional mathematically related frequencies. The probe microphone records that distortion product. DPOAE testing can assess responses across selected frequency regions and may be used to build a frequency-specific picture of cochlear outer-hair-cell function. The result is still not equivalent to an audiogram. ### Spontaneous otoacoustic emissions Some ears produce measurable emissions without an external test sound. These are called **spontaneous otoacoustic emissions**. They may be observed in research or specialized assessment, but their absence is common and does not indicate hearing loss. They are not the basis of most routine OAE screening.

What does a “present” OAE mean?

A present OAE means the equipment recorded a cochlear response that met the protocol's criteria at a particular frequency or frequency region. It generally supports reasonably functioning outer hair cells in that region and a sufficiently clear pathway through the middle and outer ear at the time of testing. A present response is reassuring, but it does not prove that all hearing is normal. Important limitations include: - OAEs do not directly measure conscious hearing thresholds. - They do not evaluate speech understanding. - They do not assess the entire auditory nerve and brain pathway. - A response may be present in some frequency regions and absent in others. - Mild hearing changes may not be ruled out by a screening result. - Some neural hearing disorders can occur even when OAEs are present. The result should be described as evidence about cochlear function—not as a guarantee of normal hearing.

What does an absent OAE mean?

An absent OAE means the equipment did not record a response meeting its criteria under the test conditions. It does not automatically mean permanent hearing loss. Possible explanations include: - Earwax or debris blocking the ear canal or probe - A poor probe fit or unstable seal - Movement, talking, crying, or room noise - Fluid or pressure dysfunction in the middle ear - A perforated eardrum or open pressure-equalization tube affecting transmission - Reduced cochlear outer-hair-cell function - Hearing loss affecting the tested frequency region - A response that is present but too faint relative to the noise floor - Equipment, calibration, or recording artifact The clinician may inspect the ear, reposition the probe, repeat the test, perform tympanometry, or complete behavioral and electrophysiologic testing before drawing a conclusion.

“Pass” and “refer” in OAE screening

Automated OAE screening often produces a **pass** or **refer** result. A **pass** means responses met the screening criteria in that ear during that session. It lowers concern for certain degrees and types of hearing loss but does not rule out every hearing disorder or a later change in hearing. A **refer** result means the response did not meet the pass criteria. It is not the same as a diagnosis of hearing loss. A refer result can occur because of temporary ear-canal debris, middle-ear fluid, noise, movement, or a true hearing difference. Follow-up or rescreening should occur according to the screening program or clinician's instructions. Use the word “refer” carefully. It means additional evaluation is needed; it does not mean the patient failed as a person or definitively has hearing loss.

Why can the outer or middle ear affect an inner-ear test?

OAE testing evaluates a response generated in the cochlea, but the test sound must first travel inward through the ear canal and middle ear. The emission must then travel outward through that same pathway to reach the probe microphone. Earwax, middle-ear fluid, abnormal pressure, eardrum problems, or an open tube can weaken or block either direction of travel. The equipment may therefore record no emission even when some outer-hair-cell function is present. Otoscopy and tympanometry help determine whether an outer- or middle-ear condition may be influencing the OAE result.

OAE testing vs. a standard hearing test

OAE testing and behavioral audiometry answer different questions. | Test | Main question | Patient response required? | |---|---|---| | **OAE testing** | Is measurable cochlear outer-hair-cell activity present under the test conditions? | No behavioral response | | **Pure-tone audiometry** | What are the softest tones the person can detect at different frequencies? | Yes | | **Speech audiometry** | How softly can speech be detected and how clearly can words be recognized under controlled conditions? | Yes | OAE results cannot be converted directly into an audiogram. Two people with similar emissions may not have identical behavioral thresholds, and a present OAE does not describe how well someone understands speech in daily life.

OAE testing vs. auditory brainstem response testing

**Auditory brainstem response**, or **ABR**, records electrical activity generated along the auditory pathway after sound is presented. Small sensors placed on the head measure the response. ABR can provide information about the auditory nerve and brainstem and can be used to estimate hearing sensitivity in people who cannot complete behavioral testing. OAE testing records acoustic energy generated mainly by cochlear outer-hair-cell activity. It does not use head sensors and does not directly evaluate the same neural pathway as ABR. The tests are often complementary. For example, a pattern of present OAEs with an abnormal or absent ABR may contribute to evaluation for auditory neuropathy spectrum disorder. Neither test result should be interpreted alone.

OAE testing vs. tympanometry

**Tympanometry** changes air pressure in the ear canal and measures the eardrum and middle-ear response. **OAE testing** presents sounds and records a faint cochlear response. An abnormal tympanogram can help explain why an OAE is absent or reduced. A typical tympanogram does not guarantee a present OAE, and a present OAE does not replace a middle-ear assessment when symptoms or other results suggest one is needed.

Why are OAEs used in newborn hearing screening?

Newborns cannot raise a hand or press a button when they hear a sound. OAE testing provides objective information quickly while a baby rests or sleeps. A soft probe plays sounds and checks for the cochlear response without causing pain. OAE and automated ABR are established approaches used in newborn hearing screening. Some programs use one method; others use a staged or combined protocol. The method and required follow-up depend on the screening program and the baby's medical history. A newborn who does not pass the first screening may not have permanent hearing loss. Fluid or debris from birth, noise, movement, and probe fit can affect the result. However, follow-up should not be skipped. Timely diagnostic assessment is important when a baby does not pass rescreening or has risk factors for delayed-onset or progressive hearing loss.

OAE testing in children

OAEs can be useful when a child is too young, developmentally unable, or temporarily unwilling to complete a reliable behavioral test. They may also be used to cross-check behavioral findings or as part of school and clinical screening. The test does not show how a child responds to speech, follows directions, or hears in a classroom. Pure-tone screening is generally preferred when a child is developmentally able to complete it reliably. A complete pediatric assessment may combine behavioral testing, tympanometry, OAEs, and ABR based on the child's age and needs. Middle-ear problems are common in children and can cause absent OAEs even when cochlear function is not the primary concern. This is one reason tympanometry is often valuable after a child does not pass OAE screening.

OAE testing in adults

Adults may receive OAE testing as part of a diagnostic hearing evaluation. It can help the audiologist cross-check the audiogram, assess cochlear function in selected frequency regions, or investigate results that do not fit together as expected. Possible clinical uses include: - Supporting evaluation of cochlear outer-hair-cell function - Cross-checking behavioral hearing thresholds - Evaluating someone who cannot provide consistent behavioral responses - Monitoring cochlear function when clinically indicated - Contributing to an auditory neuropathy assessment - Comparing results across visits as part of a broader test battery OAE testing should not be marketed as a test that can predict exactly who will develop hearing loss. Age, noise exposure, middle-ear status, test conditions, and natural variation all influence results. Research continues into how OAEs may contribute to monitoring noise or medication-related cochlear changes, but interpretation must remain clinically cautious.

Can OAEs detect noise-related damage early?

Outer hair cells are vulnerable to excessive noise, and OAEs may change when cochlear function changes. This has made OAE testing useful in research and potentially helpful as one component of monitoring in selected settings. However, OAEs are not a stand-alone predictor of future hearing loss and do not replace a baseline or follow-up audiogram in a hearing-conservation program. Individual emissions vary, and results can be affected by age, sex, middle-ear function, equipment, and measurement conditions. The significance of a change should be determined by a qualified professional using repeatable testing and other evidence.

Can OAEs detect hearing loss caused by medication?

Some medications can damage structures in the inner ear. An audiologist may include OAEs in an ototoxicity-monitoring program because they provide frequency-related information about cochlear outer-hair-cell function without requiring a behavioral response. Monitoring decisions depend on the medication, dose, treatment schedule, baseline hearing, age, health history, and clinical protocol. Patients should not stop or change medication because of an OAE result. Concerns should be discussed promptly with the prescribing medical team and audiologist.

What can make a result unreliable?

OAEs are very faint, so recording quality matters. Results may be affected by: - Environmental sound - The patient's breathing, movement, speech, crying, or chewing - A loose or poorly sized probe tip - The probe touching the ear-canal wall - Earwax, debris, or moisture in the probe - Middle-ear pressure or fluid - Device or calibration problems - A high noise floor at particular frequencies Audiologists review the recording rather than accepting every automated label without question. Repeating the test after adjusting the probe or waiting for quieter conditions is common.

How should you prepare?

Most people do not need special preparation. Before testing: - Tell the clinician about ear pain, drainage, surgery, tubes, or a known perforation. - Bring previous hearing-test results when available. - Do not place cotton swabs or other objects into the ear canal. - Avoid trying to remove deep earwax yourself. - For a child, explain that a soft ear tip will play quiet sounds and that staying still helps the test finish faster. Newborns and infants often test most easily when calm, recently fed, and sleeping. Follow the screening program's specific instructions.

What happens after an absent or reduced OAE?

The next step depends on age, symptoms, screening setting, ear examination, and other results. The clinician may: - Reposition the probe and repeat the measurement - Examine the ear canal and eardrum - Perform tympanometry - Complete pure-tone and speech audiometry - Arrange an ABR or another electrophysiologic test - Recommend rescreening within a defined timeframe - Refer to an ear, nose, and throat physician or another medical professional - Compare the result with an earlier baseline An absent response should lead to appropriate follow-up, not an immediate conclusion about the cause or severity of hearing loss.

When should you seek medical care?

Seek prompt care for ear pain, drainage, bleeding, fever with ear symptoms, significant dizziness, facial weakness, or symptoms after an injury. A sudden decrease in hearing requires urgent medical assessment even if an OAE screening was previously normal. Children with delayed speech, inconsistent responses to sound, developmental concerns, or caregiver concern should receive professional evaluation even if they passed newborn screening. Hearing can change after birth, and screening does not eliminate the need to respond to new concerns.

Questions to ask about OAE results

- Which type of OAE test was performed? - Were responses present in both ears and across which frequencies? - Was the recording quiet and reliable? - Could earwax or middle-ear function have affected the result? - Does the OAE pattern agree with the audiogram? - Is tympanometry or ABR recommended? - Is this a screening result or part of a diagnostic evaluation? - When should the test be repeated? - Which symptoms should prompt faster follow-up?

The bottom line

Otoacoustic emissions are faint sounds generated by activity in the cochlea. OAE testing records those sounds with a small ear-canal probe and provides objective information about outer-hair-cell function. The test is quick, noninvasive, and does not require a behavioral response. It is widely used in newborn screening and can add valuable information in children and adults. But it does not measure the quietest sound a person hears, evaluate speech understanding, or assess the entire auditory pathway. A present OAE is not proof of completely normal hearing, and an absent OAE is not automatically proof of permanent hearing loss. The most accurate interpretation combines OAEs with otoscopy, tympanometry, behavioral audiometry, ABR when indicated, symptoms, and medical history.

Frequently asked questions

What does OAE stand for?

OAE stands for otoacoustic emission. It is a faint sound produced by activity in the inner ear that can be recorded in the ear canal with a sensitive microphone.

Is OAE testing a complete hearing test?

No. It provides information about cochlear outer-hair-cell function but does not directly measure hearing thresholds or speech understanding. Other tests are needed for a complete evaluation.

Can I pass an OAE test and still have hearing loss?

Yes. A pass does not rule out every mild, frequency-specific, neural, progressive, or later-developing hearing disorder. Results must be considered with other tests and any hearing concerns.

Does an absent OAE mean permanent hearing loss?

Not necessarily. Earwax, middle-ear fluid, probe fit, movement, noise, and cochlear changes can all prevent a measurable response. The test may need to be repeated or followed by other evaluation.

What is the difference between TEOAE and DPOAE testing?

TEOAE testing commonly uses clicks or chirps. DPOAE testing presents two tones and measures a distortion product generated by the cochlea. Both evaluate aspects of outer-hair-cell function using different stimulus and analysis methods.

Is OAE testing painful for babies?

OAE screening is considered safe and painless. A soft probe rests in the ear canal while sounds are presented. Babies are usually screened while calm or sleeping.

Can ear tubes affect OAE results?

Yes. An open or blocked pressure-equalization tube changes sound transmission through the middle ear and may affect whether an emission is recorded. The clinician should interpret OAEs with otoscopy and tympanometry.

Can an online hearing test measure OAEs?

No. OAE testing requires calibrated equipment with a sensitive ear-canal microphone and probe. A phone, tablet, or ordinary headphone hearing test cannot record this response reliably.

Need help deciding on your next hearing-care step?

Explore hearing tests or request professional hearing help when you are ready.

Hearing Tests Request Hearing Help

Find a Provider