Of 117 children attending an aural clinic after screening positive by one or both of two tests for hearing loss at school entry, 43 (36.8%) were either seen again for review or listed for surgery. Clinical findings which were significantly associated with either being reviewed or listed for surgery, as opposed to being discharged, were the presence of conductive or sensory neural hearing loss, pronounced negative pressure, reduced compliance volume or absent stapedial reflexes on impedance testing and the presence of an abnormal tympanic membrane associated with effusion on otoscopy. This population of children were then followed up through their school medical records over 4 y to determine what proportion of those discharged from the clinic had subsequently required some form of surgical intervention due to a hearing problem. Note was also taken of all those actually receiving surgery or long term review for sensory neural hearing loss, these cases being designated as true positives in the aural clinic assessment process. This assessment, albeit of a 'high-risk group', gave rise to a sensitivity of 88.9% and a specificity of 68.0%.