Otoacoustic emission test instruments are now entering routine audiological practice. Two general classes of technique are in use in laboratory work--those employing spectrum analysers to observe the continuous generation of OAEs, both stimulated or unstimulated, and those using transient stimulation and waveform averaging to extract a delayed OAE or "cochlear echo" waveform from ear canal sound. Both methods have particular advantages in clinical applications. The transient OAE type of method has proved very effective in screening applications, particularly in neonates. It is possible to perform noninvasive screening acoustic cochleography in about a minute. The technique is also useful for characterizing cochlear mechanical status prior to long term monitoring. Achieving routinely reliable OAE test performance in clinical and screening applications under nonideal conditions makes special demands on the instrumental design and the response evaluation procedures. The essential requirements are reviewed and discussed in a general and specific context. We have tried to meet these requirements in a transient evoked otoacoustic emission system (the ILO88) which we designed to operate with a personal computer. We report on our design of probe, and our use of evaluation procedures for probe fit, and response quality. Signal processing methods have been developed to reject noncochlear acoustic responses, and to optimise the rejection of patient noise. Examples of its clinical use, and the practical problems typically encountered are given here.