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Definitive diagnosis of hearing impairment may represent the first objective evidence of physiologic dysfunction in an infant or child with undetected associated abnormalities. The audiologist and otologist should be able to recognize many genetic abnormalities and dysmorphic syndromes. Six case summaries illustrate the importance of total evaluation of the hearing-impaired child. As an aid to eliciting important information, an associated system abnormalities questionnaire is provided.