Two sets of recommendations for impedance screening have been generated recently for use with preschool and school age children. One set of these recommendations, developed in Nashville, purports that it is premature to mass-screen on a routine basis for the detection of middle ear disease. These recommendations do encourage, however, the screening of special populations of children considered at risk for otitis media. This paper offers support for Nashville recommendations and suggests that there is a critical need for additional research before we begin to screen in mass. Areas in need of further research and clarification included the use of impedance as a screening tool, natural history and medical management of middle ear disease, and the educational and linguistic complications of middle ear disease. Hence, while the potential value for screening is recognized by the Nashville recommendations, they also recognize the need for more study of the procedure and the disease.