Two acoustic immittance screening procedures were evaluated in conjunction with pneumatic otoscopy, performed by a pediatric otolaryngologist. The subjects were 204 3- and 4-yr-old children from a rural area in eastern North Carolina. Pass-fail criteria were examined using two middle ear screening procedures: (1) a "traditional" procedure based on measures of tympanometric peak pressure and acoustic reflexes, and (2) the tympanometric measures contained within the American Speech-Language-Hearing Association's (ASHA) revised Guidelines for Screening for Hearing Impairment and Middle Ear Disorders. The traditional procedure resulted in low specificity but high sensitivity, whereas ASHA's immittance procedure resulted in high specificity but only moderate sensitivity. The negative predictive value was very high for both procedures; however, positive predictive value was low, especially for the traditional procedure. Advantages and disadvantages of the two procedures and future research needs are discussed.