This paper reviews evidence which suggests that middle ear disease with effusion and associated hearing loss, unilateral sensorineural hearing impairment, and mild bilateral sensorinural hearing loss in children can result in far more educational and/or communicative difficulty than was previously supposed. The author rejects the notion that a decibel level on an audiogram truly reflects the degree of hardship the child experiences and argues for a more active identification and management program in the early years.