The purpose of the present investigation was to compare the performance of the acoustic otoscope/DPU-411 printer and acoustic immittance with otoscopic examinations by a physician for the detection of middle ear effusion (MEE). Three hundred and two patients (11 months to 69 years) were evaluated with the acoustic otoscope, acoustic immittance, and otoscopic examinations. The patients were divided into two age groups for data analysis: 1 to 12 years (children) and 13 to 69 years (adults). Reflectivity and angle data were evaluated at different cut-off points and receiver operating characteristics (ROC) curves were determined. The variables were analyzed in different combinations for each study group. Sensitivity and specificity were poorest for the acoustic otoscope in children. Furthermore, acoustic immittance data compared more favorably with otoscopy than did the acoustic otoscope for all ages.