This paper presents a novel use of innovation to tackle the challenges of providing school-age hearing screening in low and middle income countries (in this case Nicaragua, second poorest in the western hemisphere), from the creators of a tablet-based audiometer and a US hospital. They report that if school-based screening existed in Nicaragua it would identify a hearing loss in 18% of children which, if addressed early in their life, could have a positive impact for many. The WAHAT (Wireless Automated Hearing Test System) claims to be superior to the many other currently available automated tablet-based hearing test systems due to its levels of noise attenuation – particularly essential in the noisy environment encountered in school hearing screening. The first 101 students, aged seven-to-eight years old, who underwent the automated tablet-based audiogram then all went on to have an audiological assessment in hospital with an audiologist-led manual version of the tablet audiometer, and then a formal audiogram in soundproof booth. No children with a hearing loss were ‘missed’ by the automated tablet audiometer (100% sensitivity) and a further 19 recruits to the study only had hospital-based audiology assessment if there was an abnormality identified on the school screening test. The specificity of the automated WAHAT is low, at 76%, and although comparable to other products currently available, this is an area in which all tablet audiometers lag behind. Background noise and keeping children’s attention impact the sensitivity. This is an interesting emerging area, and certainly there is further work to do, with much larger studies than this, in a variety of settings and from authors without commercial interests in the product.