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One of the most common reasons newborn hearing screening professionals reach out to COEHDI for technical support is when they notice an increase in “did not pass” or “refer” rates. More often than not, this issue is related to problems with newborn hearing screening equipment. The good news? Most of these technical issues are easily understood and have simple solutions.
The following troubleshooting tips can help you with your newborn hearing screening equipment. But first, we recommend that you consider the screening environment to ensure it is optimal. Screening should take place in a quiet room away from noise and electrical sources. Ideally, the baby will have a clean diaper, be fed and swaddled, and sleeping.
Conducting daily listening checks and annual calibration also help to ensure that your newborn screening equipment is in working order.
Troubleshooting Tips - Otoacoustic Emissions (OAE) Equipment
Problem 1: Incorrect Size Probe Tip
A tight seal of the probe in the baby’s ear is necessary to obtain accurate OAE measurements. Too large a probe tip or too small a probe tip can introduce too much background noise, leading to increased “did not pass” or “refer’ rates. A good way to check whether you have a good probe fit is to give the probe a one-quarter turn as you place it in the ear. Another way to ensure that you have a good probe fit is to gently tug on the probe tip. If it slides out with little resistance, it is too loose.
Problem 2: Incorrect Positioning of Probe Tip
A poorly positioned or seated probe tip can prevent the sound stimulus from reaching the baby’s ear and from measuring the responses from the inner ear. Try pulling straight back on the pinna before positioning the probe tube in the ear. Refer to the steps above to check for a good probe fit. You should not need to hold the probe in place while screening; in fact, holding the probe tube can lead to poorer placement in the ear canal when the probe tip touches the canal wall or can introduce additional noise, leading to inaccurate measurements.
Problem 3: Clogged Probe Tip
Babies may have vernix (white, waxy substance) or cerumen (earwax) in their ears which can clog the probe tip. A clogged probe tip does not allow the sound stimulus to reach the baby’s ear effectively. It can also affect the ability to accurately record the response from the baby’s inner ear, leading to increased “did not pass” or “refer” rates. A good way to ensure that your probe tip is not clogged is by performing a daily listening check on yourself to make sure you can hear the sound stimulus. Refer to the user manual or manufacturer of your equipment for specific instructions on how to clean the probe tip.
Problem 4: Collapsed Ear Canals
Because baby ear canals are soft and sticky, the baby's ear canals can collapse, leading to poor fit of the probe tip in the ear. To prevent collapsed ear canals, gently massage the area in front of the ear for 10 seconds in a circular motion before inserting the probe tip into each ear.
Troubleshooting Tips - Automated Auditory Brainstem Response (AABR) Equipment
Problem 1: Electrodes Not Plugged in or Not Plugged in Properly
This one is a no-brainer, but it happens to the best of us! Check that all of the electrodes are plugged in and plugged into the correct ports.
Problem 2: Impedance Levels Are Too High
Electrodes placed on the baby’s head must make good contact with the skin in order to obtain accurate AABR measurements. In general, impedances should be very low (less than 5 kOhms). If impedances are too high, scrub the baby's skin again, or try using electrode paste to ensure better contact with the skin. As you place the electrodes on the baby’s head, use firm pressure for a few seconds to make sure the electrode sticks.
Problem 3: Clogged Earphone
Babies may have vernix (white, waxy substance) or cerumen (earwax) in their ears, which can clog the earphone. A clogged earphone does not allow the sound stimulus to reach the baby’s ear effectively. A good way to ensure that your earphone is not clogged is by performing a daily listening check on yourself to make sure you can hear the sound stimulus.
Problem 4: Electrical Interference
Nearby medical equipment in the room can introduce electrical interference while screening via AABR. If the baby is in a portable bassinet or crib, try moving it as far from medical equipment and monitors as possible. Crossed electrode cables can also introduce additional electrical noise. Orient the electrode cables in the same direction (away from the top of the baby’s head) and make sure the electrode cables are not crossed.
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