Current clinical methods of assessment of the middle ear in children include otoscopic examination, acoustic immittance measures, and reflectometry. When assessing middle ear function, a good otoscopic evaluation is the first step. Examination of the ear canal for any obstructions that would preclude placement of a probe such as is used for acoustic immittance measures is essential. Often, cerumen in the ear canal becomes impacted, even in children, and thereby confounds tympanometric measures. Even when not impacted, cerumen can clog the immittance probe and cause invalid measurements.

Otoscopy can also be useful in identifying middle ear disorders such as middle ear effusion. Examination of the tympanic membrane can provide evidence of fluid by its opacity or color. An opaque or yellow membrane, for example, might indicate middle ear effusion. Clearer evidence comes when a fluid meniscus or bubbles can be seen through a transparent tympanic membrane. Someone skilled with pneumatic otoscopy can examine the membrane's mobility by applying slight changes in air pressure in the ear canal. However, the ability to use a pneumatic otoscope for the diagnosis of middle ear effusion is highly variable. Of course, in the clinical examination associated with the diagnosis of middle ear effusion, visual examination of the ear canal and tympanic membrane is important so that other conditions (e.g., cholesteatoma, retraction pocket) may be identified.