Conductive hearing loss may be responsible for poor school performance if not recognized early and is controllable by appropriate medical and/or surgical therapy. This study was designed to evaluate the diagnosis of abnormal middle ear function in the setting of an ordinary pediatric office. The population of allergic children studied was likely to have a high incidence of this disorder. The diagnostic procedures employed were pneumatic otoscopy, Rinne and Weber tests using a tuning fork of 256 hertz, and screening audiometry to identify a 25-dB (International Standards Organization) hearing loss at frequencies of 500, 2,000, and 4,000 Hz. Of 1,222 children studied, 278 (22.6%) had evidence of abnormal middle ear function, confirmed by otological consultation. The examination was carried out successfully without a sound-proof room. Such an evaluation should be a part of the well-child examination.