The need for the early identification of children with permanent childhood hearing impairment (PCHI), most of which is congenital, has long been recognised in the UK. The early work of the School Medical Service, and of the Ewings in Manchester,1supported by key developments elsewhere in the UK, led in the 1960s to a de facto national screening programme. This was configured around a “distraction test” screen performed by health visitors at 7–9 months, and a back up screen at school entry. Although the introduction of the Infant Distraction Test (IDT) probably resulted in a significant reduction in the median age of identification for PCHI, by the early 1980s doubts were being expressed about the performance of the screen,2 despite its endorsement by the government’s Advisory Committee on Services for Hearing Impaired People.3 These doubts led to notable and partially successful efforts by some to improve the IDT by better training, equipment and protocols.4-8

However, doubts remained, particularly as the limited data available indicated that for a large proportion of children the age of identification of congenital hearing impairment continued to be very late. In some developed countries, such as Holland, effort was directed towards a more automated version of the UK IDT, backed up by better information systems. In others, where community services were less well developed—the USA, for example, interest centered on technological developments which might permit hearing screening of neonates.

In the 1980s two neonatal screening techniques were developed, one based on the Auditory Brainstem Response (ABR),8 the other on Transient Evoked Otoacoustic Emissions (TEOAE).9In ABR screening clicks are presented to the baby’s ear and the resulting electrical activity generated by the eighth nerve and lower brainstem pathways are picked up by surface electrodes and averaged; in automated versions a …