Page 52 - JCTR-11-4

Journal of Clinical and
Translational Research Female are better in otoacoustic emissions tests

screening protocols to account for gender differences may signs of subtle auditory deficits, as better responses may
enhance the accuracy and effectiveness of early auditory mask mild dysfunctions.
assessments. Below are potential considerations and
suggestions for adapting screening protocols. 4.2.5. Risk stratification based on prenatal and
hormonal factors
4.2.1. Adjustment of thresholds for screening results Prenatal exposure to hormones like testosterone can

Setting the same pass/fail thresholds for both sexes may influence auditory development. Male neonates, especially
lead to a higher rate of false positives in males and false those from multiple pregnancies or with indicators of
negatives in females. Changes in protocols can include high androgen exposure, may require closer monitoring.
developing sex-specific thresholds for OAE amplitude It is necessary to integrate prenatal history into screening
and response times or establishing normative data for protocols to identify neonates at higher risk of auditory
OAE responses in male and female neonates to guide issues. It will be necessary to include questions about
individualized assessments. prenatal androgen exposure (e.g., multiple pregnancies or
maternal hormonal treatments).
4.2.2. Improvement in the test performance in males
For instance, a higher threshold for passing might be set 4.2.6. Gender-specific recommendations for early
for male newborns to account for their lower sensitivity, interventions
thereby reducing false positives and unnecessary follow- By incorporating these considerations into neonatal
ups. Another option would be to increase the TEOAE hearing screening protocols, healthcare providers can
stimulus in males to compensate for gender differences, as achieve a more nuanced and effective approach, ensuring
females have OAEs of larger amplitude than males. With better outcomes for both male and female neonates.
an increment in the click stimulus rate, the significance of In the future, and following the trend of personalized
this difference would be reduced. 27,28
medicine, with the aid of artificial intelligence, other
These two measures can be easily included to known factors that modify the response to OAEs should
automatically modify screening devices currently in use also be taken into account. These factors could be included
with the introduction of the neonate’s sex. However, it can in the newborn’s medical record and used to adjust the
be difficult to implement due to the characteristics of the “pass” criteria of the devices utilized for the test. For
cochlear response. Hence, more studies are needed before instance, breastfeeding is a highly positive factor that
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this implementation. should be compensated for in neonates who are formula-
An alternative approach would be to perform the test fed. Similarly, a cesarean delivery allows the test to be
as late as possible for males to facilitate a better response performed later on the newborn (as they tend to stay in
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on the first attempt, while performing the screening earlier hospital longer), which can result in a better response.
for females. It would be interesting to conduct longitudinal studies
following twins over time to evaluate how these initial
4.2.3. Consider anatomical and functional differences differences in EOAEs may influence later auditory and
in screening design linguistic development. For example, as highlighted in
Structural differences in cochlea length and outer hair cell Nolan’s study, taking sex into account as a biological
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functionality suggest that females might have a natural factor is essential for studying the etiology of agerelated
advantage in detecting high-frequency sounds. One auditory decline. Ageingrelated loss of hearing is selective
could adjust screening frequencies to account for these across frequencies and varies according to sex. Evidence
differences. For example, slightly lower frequencies may be further suggests that male–female distinctions in cochlear
emphasized in male neonates to improve detection rates. function are evident from neonatal life. Clarifying the
molecular underpinnings of these sex differences may
4.2.4. Tailor follow-up recommendations accelerate the development of targeted therapeutic
Males might be at a higher risk of failing initial screenings approaches in precision medicine.
without having true auditory dysfunction due to potentially
weaker OAEs influenced by hormonal and prenatal factors. 4.3. Twins study
Hence, protocols may implement a repeat screening at In our study on twins, when the group is analyzed as
discharge before recommending additional diagnostic a whole, the effect of gender is not significant. This may
procedures for male neonates with borderline test results. be due to the presence of a stronger factor: The day of
For female neonates, consider higher sensitivity as early the discharge examination. The incidence of caesarean

Volume 11 Issue 4 (2025) 46 doi: 10.36922/jctr.8416