In this study tympanometry and otoscopy were conducted in 893 children in Kuwait. Otoscopic examination revealed pathologic findings in 41.7%, while 30.6% had type B or C tympanograms. Based on referral criteria commonly used in tympanometry 31% of the children should be referred for further evaluation. Using the combined otoscopic and tympanometric evaluation of the ears the referral rate could be reduced to 18%.