Immittance procedures and medical evaluation based on case history and otoscopy were administered to 115 youngsters from a large pediatric practice. Using ASHA immittance guidelines, a reasonable 73% overall agreement was achieved between immittance and medical recommendations of “pass,” “at risk,” and “fail/treat.” When using medical findings as the criterion, there were three definite cases of under-referral (false negatives) and five over-referrals (false positives) in this sample group.