CC BY-NC-ND 4.0 · Semin Hear 2023; 44(01): 029-045
DOI: 10.1055/s-0043-1764200
Original Article

Use of Wideband Acoustic Immittance in Neonates and Infants

Hammam AlMakadma
1   Department of Otolaryngology and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky
Sreedevi Aithal
2   Hearing Research Unit for Children, School of Health and Rehabilitative Sciences, The University of Queensland, Queensland, Australia
3   Department of Audiology, Townsville University Hospital, Townsville, Australia
Venkatesh Aithal
2   Hearing Research Unit for Children, School of Health and Rehabilitative Sciences, The University of Queensland, Queensland, Australia
3   Department of Audiology, Townsville University Hospital, Townsville, Australia
Joseph Kei
2   Hearing Research Unit for Children, School of Health and Rehabilitative Sciences, The University of Queensland, Queensland, Australia
› Author Affiliations


With widespread agreement on the importance of early identification of hearing loss, universal newborn hearing screening (UNHS) has become the standard of care in several countries. Despite advancements in screening technology, UNHS and early hearing detection and intervention programs continue to be burdened by high referral rates of false-positive cases due to temporary obstruction of sound in the outer/middle ear at birth. A sensitive adjunct test of middle ear at the time of screening would aid in the interpretation of screening outcomes, minimize unnecessary rescreens, and prioritize referral to diagnostic assessment for infants with permanent congenital hearing loss. Determination of middle ear status is also an important aspect of diagnostic assessment in infants. Standard single-frequency tympanometry used to determine middle ear status in infants is neither efficient nor accurate in newborns and young infants. A growing body of research has demonstrated the utility of wideband acoustic immittance (WAI) testing in both screening and diagnostic settings. Wideband power absorbance (WBA), a WAI measure, has been shown to be more sensitive than tympanometry in the assessment of outer/middle ear function in newborns. Furthermore, age-graded norms also support successful application of WBA in young infants. Despite its merits, uptake of this technology is low among pediatric audiologists and hearing screening health workers. This report describes normative data, methods for assessment and interpretation of WBA, test–retest variations, and other factors pertinent to clinical use of WAI in newborns and infants. Clinical cases illustrate the use of WAI testing in newborn and infant hearing assessment.

* H.A. and S.A. have jointly contributed as first authors.

Publication History

Article published online:
01 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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