SummaryA paediatric hearing assessment unit was set up in Lothian in 1978 to provide a clear referral pathway for children with suspected sensorineural hearing impairment and particularly for those children detected by the health visitor screening test.Over a 6‐year‐period the incidence of bilateral sensorineural deafness was 1–3/1000 suggesting that all children in the region were being seen. The mean age of diagnosis fell significantly over this period. Children in high risk groups, through adverse perinatal events or a positive family history, were not detected any earlier than other children. They were therefore not contributing to this improved earlier age of diagnosis. These findings support the continuation of health visitor screening but changes in practice are needed to encourage earlier diagnosis in high‐risk