The prevalence of hearing impairment among 10-year-old children in metropolitan Atlanta between 1985 and 1987 was evaluated. Hearing-impaired children were identified by reviewing records at public schools and health and social service agencies. The prevalence was 1.1 per 1000 and was slightly higher among Blacks and boys than among Whites and girls. The most common known causes of hearing impairment were meningitis (0.3 per 1000), genetic and hereditary conditions (0.2 per 1000), and congenital rubella syndrome (0.1 per 1000). For 55% of the children, the etiology of the hearing loss could not be determined. Most (74%) of the children were diagnosed after the age of 2, suggesting that methods of early identification need to be improved.