Carlos Miguel Angelats-Romero

Background: Evoked otoacoustic emissions are one of the most widely employed techniques in assessing neonatal hearing. However, several factors may influence the outcomes of this test. One such factor is gender, as previous research has shown that females tend to exhibit a greater otoacoustic response than males. Aim: This study evaluates whether gender influences the pass rate of the otoacoustic emissions test in neonatal hearing screening, using data from both the general population and twin pairs. Methods: Data from the Newborn Hearing Screening (NHS) program and infant gender were collected between 2002 and 2023 from 22,825 healthy newborns in the maternity or neonatal ward. Of these, 586 cases were from twin pregnancies. A separate analysis was conducted for twins, distinguishing between same-sex and opposite-sex pairs. Results: A highly significant difference (p<0.0001) in NHS pass rates was observed in favor of females, who demonstrated better responses to the test. In the twin subgroup, analysis of the 112 discordant-sex pairs with differing test outcomes revealed a statistically significant result (p<0.023), further supporting the positive effect of female sex on successfully passing the hearing screening test. Conclusion: Female newborns exhibit stronger otoacoustic emission responses and higher pass rates in the NHS test compared to male newborns. These gender-based variations in otoacoustic emission responses may have important implications for the NHS, as otoacoustic emissions are a commonly used screening tool in neonatal hearing assessment. Relevance for patients: Recognizing and accounting for these gender-based differences in otoacoustic emission responses may inform modifications to screening program protocols, potentially improving the identification of hearing impairment in newborns.