This study was conducted on 34 children with chronic renal failure: 27 on regular haemodialysis and seven on conservative treatment. Twenty normal healthy children served as controls. They were subjected to clinical examination including otoscopic examination, basic audiological assessment and transient otoacoustic emission testing (TOAE). Four patients had a conductive hearing loss and five had a bilateral moderately severe high frequency sensory neural hearing loss. TOAE testing was carried out for the rest whose ears displayed normal hearing. No response (fail) was obtained in 8% of them but in none of the controls and a partial pass response in 38% versus 10% of controls (P < 0.001). Cochlear dysfunction was significant only at low frequency levels. The mean overall echo-level and reproducibility were significantly lower in patients than in controls. The same holds true for the subgroup of patients on haemodialysis but not for those on conservative treatment. The overall echo-levels did not correlate with serum urea, creatinine, sodium or potassium.