The value of otoacoustic emissions as an objective screening test for normal peripheral auditory function in infants is currently the subject of extensive and promising research. Additionally the measurement of cochlear emissions is potentially useful when children cannot be tested reliably by traditional subjective methods but confirmation of normal hearing is diagnostically important. Three groups of children are described who present such audiological dilemmas: children with non-organic hearing loss, children with severe learning difficulties and more rarely children with an abnormal auditory brainstem response who also have damage to the central nervous system. In all three groups otoacoustic emission testing was found to be diagnostically useful in determining normal peripheral auditory function thereby resolving some of the dilemmas facing paediatric audiology and ENT clinics.