Otoacoustic emissions have been used as an objective and noninvasive test of cochlear function. Due to its ease of use, accuracy, and test-retest reliability, otoacoustic emissions testing is considered an excellent tool for evaluating difficult-to-test patients. This project involved screening infants at high risk of congenital hearing loss. These infants were selected from the Special Infant Clinic at Queen's University, Kingston, Ontario. The first part of this project was to establish a distortion product otoacoustic emissions (DPOAEs) "norm" as the reference for this group of patients. A prospective study was then conducted to compare DPOAE and auditory brainstem response (ABR) as screening tools for this group of patients. Auditory brainstem response has been the gold standard for evaluating the hearing status of these infants. We will also present our experience in testing over 50 patients at high risk of congenital hearing loss using DPOAEs.