The micro-otoscopic, audiometric and tympanometric findings were correlated in 204 ears seen in a Veterans Administration Hospital ear clinic. Otoscopy, audiometry and tympanometry were done during the same clinical visits. In most cases pneumo-otoscopy with the microscope also was performed. Because we were unable to standardize pressures, we found pneumo-otoscopy of limited value. The data in this series were analyzed from two different points of view to determine the accuracy of the tympanometer in detecting and identifying ear disease. First the otoscopic results were compared with the tympanometric findings. Second, the procedure was reversed and various tympanometric findings were compared to the otologic diagnosis. Otophotographs were obtained in many of the ears to record findings. An otologic evaluation consists in physical and functional examinations and is not complete without both elements. It is important to remember that the tympanogram does not measure hearing loss. Tympanic membrane abnormalities can invalidate measurements of acoustic impedance and lead to a false interpretation of tympanometric findings.