A survey was carried out to identify the prevalence and the aetiology of hearing impairment among infants and children at risk based on the criteria. Out of 6421 surveyed children. 1256 (19.6%) were found "at risk' for hearing impairment. Children with hearing impairment in this study were found to be 494 which represent 39.3% of the "at risk' children. We found 326 (66%) children had conductive hearing loss almost all associated with secretory otitis media (n = 232). Sensorineural hearing loss affected 168 (34%) children. Heredo-familial causes were responsible for about 111 (66.1%) cases. The detailed causes of conductive and sensorineural hearing loss are presented and compared with other studies in the literature. Conductive hearing impairment was mild in the majority of the cases n = 271, (83%), moderate in 55 (17%) cases. Sensorineural hearing loss was mild in 113 (67.3%), moderate in 32 (19%) and profound in 23 (13.7%) cases. A large scale Kingdom-wide study to focus on aetiology of deafness among Saudi infants and children to find out the extent of this problem is recommended.