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BACKGROUND: Spontaneous otoacoustic emissions (SOAEs) are regarded as a valuable audiometric parameter that objectively reflects the function of outer hair cells (OHCs). Many studies have reported that the incidence of SOAEs in adults is less than 50%. Therefore, measurement of SOAEs may be of little value to clinical examinations. However, the incidence of SOAEs in infants and neonates is higher than in adults.OBJECTIVE: To analyze the basic characteristics of SOAEs in 2-4 day old neonates, and to demonstrate the difference in OHC function between sexes and ears.DESIGN, TIME AND SETTING: Neurophysiological contrast study, performed in the Department of Neonates, Beijing Chaoyang Hospital, Capital Medical University, between December 2007 and August 2008.PARTICIPANTS: A total of 112 newborns (224 ears) consisting of 59 females and 53 males were included in this study.METHODS: The probe was adapted and embedded in the neonate external auditory canal with a foam rubber earplug after checking and clearing up the outer ear canal. The presence of SOAEs was determined when the signal amplitude had a clear peak exceeding -30 dB, or was 3 dB above the noise floor.MAIN OUTCOME MEASURES: The incidence of SOAEs, the number of SOAE signal peaks, and the maximal tension of SOAEs.RESULTS: The incidence in females (79.7%) was higher than males (76.4%) (P> 0.05), and the incidence in right ears (86.6%) was higher than in left ears (69.6%) (P< 0.05). There were no significant difference in the number of SOAE peaks between females and males (4.49 vs. 4.28), or between right ears and left ears (4.62 vs. 4.12) (P> 0.05). The mean maximum SOAE level per ear in females (-3.29 ± 9.28) dB sound pressure level (SPL) was slightly higher than that in males (-3.91 ±9.14) dB SPL(P>0.05). Also, the mean maximum SOAE level in right ears (-2.03 ±9.11) dB SPL was higher than in left ears (-5.50 ± 9.65) dB SPL (P < 0.05). The maximum SOAE level showed a positive correlation with maximum SOAE number in emitting ears (r= 0.55, P< 0.01).CONCLUSION: The incidence of SOAEs in neonates is high (78.1%) within 4 days of birth. The incidence of SOAEs and the maximum SOAE level exhibited a significant difference between right and left ears, but the difference between sexes was insignificant. Both the strongest SOAE signal peak and number of SOAEs per ear are representative of the function OHCs.