The aim of this study was to assess the effect of a specific educative process on the accuracy of parental observation regarding the child's hearing status. The presence or absence of parental concern in two groups of subjects, one of which had undergone the educative process, was elicited by direct questioning and its accuracy checked by formal hearing assessment. The results indicate that there is no significant difference in the reliability of parental observation between the two groups. However, both groups were selected from the same high awareness district and one could postulate that the effect of the educative process was minimized because the 'uneducated' group, as discussed, was in fact not totally uneducated. This is supported by the high accuracy of parental suspicion in hearing impaired children in this latter group compared to that reported in other studies. These results support the use of parental observation as part of a screening programme for the detection of hearing impairment in childhood.

The pace of medical change is in danger of paralysing the process of decision making, particularly in services where clinical improvements occur more slowly than the introduction of new interventions. Audit within an individual district enables staff to monitor progress towards desired goals and standards but rarely generates sufficient data to inform decision making about major policy changes. The paper describes how the findings from nine audits of a community paediatric audiology service over a 13-year period were combined with reviews of the literature, resulting in a series of changes to a children's audiological service. The interest and commitment of all the staff involved were maintained by involving them in the process and using them as a valuable source of qualitative data. Audit must be thorough and should be based on precise case definition and comprehensive casefinding if the results are to be meaningful. It is a more powerful means of achieving improvements in systems if it is combined with research evidence, and a readiness to change the system if the agreed goals are not being attained.

The aim of this study was to assess whether mothers whose first language is not English are as accurate as English speakers in reporting on their child's hearing. Some Health Trusts are using parental report following an educative process as part of their screening programme for hearing impairment. At present, in Wandsworth, London, UK, where there is a relatively high ethnic minority population, many of whom speak little or no English, the parental educative programme is carried out in English. There are many studies supporting the translation of the educative programme into appropriate minority languages but the authors wanted to assess whether doing so would actually improve the hearing impaired identification rate by the raised awareness programme. The presence or absence of concern in the two groups of mothers, one English speaking and the other non-English speaking, was elicited by direct questioning and its accuracy checked by formal hearing assessment. The results indicate that there is no significant difference in the reliability of maternal observation between the two groups in normal hearing and hearing impaired children. However, two-thirds of non-English speaking mothers of hearing impaired children were not concerned about their child's hearing status, compared to one-fifth of the English speaking mothers. Although the numbers of hearing impaired children are small, and the reason for the high maternal inaccuracy in non-English speakers in this group has not yet been ascertained, it seems reasonable to recommend translation of the parental educative leaflets in Wandsworth into minority languages. This recommendation is supported by other studies.