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Page 22

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Welch Allyn OAE Hearing Screener Directions for Use 705353 Rev E

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PEDIATRIC HEARING SCREENING RESULTS


Date of Exam:________________________

Patient’s Name:________________________

Date of Birth:________________________

This patient's hearing was screened using otoacoustic emissions. The

patient

passed the hearing screening in both ears, which indicates that hearing

is adequate for normal speech and language development. No further testing is
recommended at this time.

A delayed onset hearing loss can develop and this screening does not

rule out the need for future evaluation if parental concerns regarding speech and
language development arise or if future medical events place this child at risk for
a hearing loss. The Joint Committee on Infant Hearing advises that follow-up
hearing evaluations occur if this patient has a congenital infection, or a family
history of hearing loss. If you have questions concerning the screening, do not
hesitate to contact us.









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