During the past 80 years, British hearing scientists and audiologists have made important contributions to the scientific investigation and clinical application of otoacoustic emissions (OAEs). As early as 1946, Thomas Gold conducted pioneering research in the Cavendish Laboratory at Cambridge University that confirmed active processes within the cochlea.
In 1978, 30 years after Gold’s initial publications describing his discovery of mechanical resonators within the inner ear, David Kemp of the Institute of Laryngology and Otology (ILO) in London published his classic paper describing what we now call otoacoustic emissions. Within the next decade, audiologists in the UK and elsewhere reported on multiple clinically valuable applications of OAEs, ranging from newborn hearing screening to the diagnosis of auditory neuropathy. Readers will find a detailed historical perspective in the Otoacoustic Emissions: Principles, Protocols, and Procedures [1].
Figure 1.
Diverse evidence-based clinical applications in children and adults
The literature contains more than 6500 peer-reviewed publications on the general topic of ‘otoacoustic emissions’. Figure 1 shows the number of publications per year from 1981 to January 2026, as identified with the search engine PubMed (https://pubmed.ncbi.nlm.nih.gov). The arrow highlights a marked increase in published OAE research beginning in 1994, presumably resulting in part from the availability of multiple new distortion product OAE (DPOAE) devices from major manufacturers of audiologic equipment [1,2].
Thousands of peer-reviewed publications describe evidence-based clinical applications of OAEs in children. Since the early 1980s, OAEs have consistently been a popular technique for newborn hearing screening. OAEs offer multiple advantages for detection of hearing loss newborn infants, as well as preschool and young school-age children. Among the advantages are brief test time, automated technology permitting screening by non-audiologists, and sensitivity to cochlear and middle ear dysfunction.
"It’s not an exaggeration to state that increased clinical application of OAEs in the 1990s led directly to the recognition of auditory neuropathy spectrum disorder"
Due to their high degree of sensitivity to and site-specificity for cochlear dysfunction, OAEs contribute importantly to the prompt and accurate diagnosis of paediatric and adult hearing loss resulting from a variety of aetiologies. It’s not an exaggeration to state that increased clinical application of OAEs in the 1990s led directly to the recognition of auditory neuropathy spectrum disorder (ANSD). The typical pattern of findings in ANSD is normal DPOAEs and absent acoustic reflexes and/or auditory brainstem response (ABR). OAEs are also particularly well-suited for ototoxicity monitoring due to their high degree of sensitivity and frequency-specificity in detecting outer hair cell dysfunction. Valid OAE measurement is feasible, even in ill or very young children or adults. The use of OAEs for ototoxicity assessment and monitoring is recommended in clinical practice guidelines.
The same advantages of OAEs – high degree of sensitivity to cochlear auditory dysfunction – apply to other paediatric and adult patient populations. OAEs are very useful for the diagnostic assessment of patients at risk of noise- or music-induced hearing loss, and for patients with bothersome tinnitus and/or hyperacusis and other disorders of decreased sound tolerance. In addition, an explanation of OAE findings often contributes to more effective counselling of patients and parents. Finally, clinical research and experience confirm that normal OAE findings in patients with abnormal audiograms suggests the possibility of a false hearing loss, and the need for further diagnostic assessment with additional objective procedures, such as auditory evoked responses.
"Emerging technological advances include smartphone-based OAE software and probes, small and very inexpensive devices that facilitate widespread and diverse OAE applications outside of traditional audiology clinics"
For more information and guidance on the measurement, analysis and clinical application of OAEs, readers are encouraged to refer to the British Society of Audiology Practice Guidance for the Clinical Application of Otoacoustic Emissions (OAEs) in Children and Adults [3].
Emerging technological advances
We are now witnessing unprecedented expansion of novel new OAE techniques and technologies, including smartphone-based OAE software and probes, small and very inexpensive devices that facilitate widespread and diverse OAE applications outside of traditional audiology clinics, and the integration of artificial intelligence (AI) into OAE measurement, analysis and clinical application. A British audiologist, Dr Mark Lutman, who was involved in the initial wave of clinical OAE studies in the 1980s is also a co-author of an early publication, describing the utilisation of AI in OAE analysis [4]. A recent article entitled ‘Deep learning models for predicting hearing thresholds based on joint stimulus-frequency otoacoustic emissions and distortion-product otoacoustic emissions’ is likely a harbinger of an exciting new OAE era [5].
References
1. Dhar S, Hall JW III. Otoacoustic Emissions: Principles, Procedures, and Protocols (2nd Ed). San Diego, USA; Plural Publishing; 2018.
2. Hall JW III, Chase PA, Baer JE, Schwaber MK. Clinical application of otoacoustic emissions: What do we know about factors influencing measurement and analysis? Otolaryngol Head Neck Surg 1994;110(1):22–38.
3. British Society of Audiology. Practice Guidance Clinical Application of Otoacoustic Emissions (OAEs) in Children and Adults; 2023. BSA OD104-120 v4.
4. Butler G, Lutman ME. Automatic classification of transiently evoked otoacoustic emissions using an artificial neural network. Br J Audiol 1998;32(4);235–7.
5. Xu R, Gong Q. Deep learning models for predicting hearing thresholds based on joint stimulus-frequency otoacoustic emissions and distortion-product otoacoustic emissions. Hear Res 2025;465:109349.
Declaration of competing interests: None declared.
