The 'healthy-baby-clinics' in Göteborg, as in all Sweden, test all 4-year-olds with pure tone screening (failure criterion greater than 20 dB). Those who fail are referred to an oto-audiological health center. In an effort to prevent over-referrals of false positives as well as under-referrals of false negatives all referred children in this study have been tested with pure tone audiometry supplemented by tympanometry. At the oto-audiological health center a test program including 3 tests with intervals of 6 weeks was initiated. Failure criteria were middle ear pressure less than - 150 mm H2O and hearing loss (HL) in the frequency range 0.125-8 kHz greater than 20 dB. In Göteborg (430,000 inhabitants) 5928 4-year-olds were tested at the 'healthy-baby-clinics' during 1980. Of these 498 (8.4%) failed in pure tone screening, 248 of which are included in the present study. At the first check in our test program, which was performed 3-8 weeks after referral, only 45% of the children were abnormal. Of these 60% normalized during the test program. Thus of the ears referred following the pure tone screening at the 'healthy-baby-clinics' only 18% remained after 15-20 weeks for referral to an ENT-doctor.