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Introduction: A universal neonatal hearing screening is recommended by the American Joint Committee on Infant Hearing (JCIH) and is rapidly becoming the standard of care, especially in the United States. In Denmark, the only screening for hearing impairment in infants is a behavioural distraction test (BOEL test) at the age of eight months, administered in the home by a health visitor. Materials and methods: Parents of 2,705 children born during a period of eight months in 1996-1997 were, by means of a questionnaire, asked if their child had had a BOEL test, what the outcome had been and whether a new test had been administered in the case of an abnormal result. In the five-year follow-up period, children who had been diagnosed as hearing-impaired were registered, including the results of their BOEL test. Results: 91% of the questionnaires were returned. 14% of the children had had an abnormal test, and 2% had never had a BOEL test done. 57% had been retested, one third of the results being abnormal again. Of these children, 60% had never been followed up and 40% had been referred to an otologist. Six children with hearing impairment were found, five of whom had a normal BOEL test and one of whom had never had a test done, giving a sensitivity of 0 and a specificity of 0.97. Discussion: The BOEL test is well established, with very high coverage but low sensitivity, resulting in unnecessary concern or false security on the part of the parents, delayed recognition and diagnosis of hearing impairment, as well as referral of many children with normal hearing levels to treatment, producing a rise in health costs. This makes the BOEL test unqualified as a screening test.

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