Objective: To estimate the sensitivity and specificity of pure-tone audiometry hearing screening in the primary care setting. Design: Prospective cohort study. Setting: Eight academic and private pediatric practices. Participants: A subset of children from a convenience sample of 1061 children between 3 and 19 years of age were screened for hearing loss using pure-tone audiometry. Intervention: Formal audiologic evaluations (gold standard) for those children referred by their primary care physician (28 children) and for a random sample of children not referred (102 children). Main Exposure: Pure-tone audiometry screening. Main Outcome Measures: Audiologic evaluations. Results: A total of 28 children were referred to an audiologist for formal hearing testing after pure-tone audiometry screening during a well-child visit, at which 25 children did not pass the initial screening and 3 could not complete the screening. Of the 25 children, only 7 were evaluated by an audiologist, for a follow-up rate of 25%. One child was diagnosed as having hearing loss. Formal audiologic assessment was also performed on a random sample of 102 children who were not referred to the audiologist. For the random sample, hearing loss was identified in 2 of 76 (3%) children who passed and 1 of 16 (6%) children who did not pass pure tone audi- ometry screening. The sensitivity and specificity of pure-tone audiometry were 50% and 78%, respectively. Conclusion: In light of the increasing burden on physicians to provide preventive care, this study calls into question the value of hearing screening using pure-tone audiometry during well-child visits given the lack of follow-up after referral and the poor sensitivity. © 2009 American Medical Association. All rights reserved.