An association between congenital hearing impairment and deprivation has been suggested, but evidence is limited. We studied children born in Greater Glasgow, 1985-94, with bilateral congenital hearing impairment. The children were divided into seven deprivation categories using the Carstairs Deprivation Index. One hundred and twenty-four hearing-impaired children were born over the study period, an incidence of 1.18/1000 live births. There was a clear association between deprivation category and incidence, ranging from 0.47/1000 to 1.72/1000. An association with deprivation was seen for children with a family history and perinatal problems (such as prematurity and low birth weight). No association was found for other aetiological groups such as craniofacial syndromes or early postnatal infection. Deprivation had no effect on age of diagnosis or hearing aid provision. Deprivation is associated with congenital hearing impairment, due to more prematurity and low birth weight in deprived families, and the fact that families with many hearing-impaired members are economically disadvantaged. There should be a strong emphasis on the needs of the socio-economically disadvantaged when planning services for hearing-impaired children.