Seven methods of hearing loss prediction by the acoustic reflex were compared in 869 subjects, aged 1 to 20 years. The seven methods were two versions of Sensitivity Prediction by Acoustic Reflex (SPAR), four regression equations, and a bivariate plot technique. While accuracy rate for each of the seven methods generally exceeded 64%, hearing loss was most accurately identified by the bivariate plot system. The proportions of predictive errors among methods, however, ranged from 22 to 31%; moderate errors predominated while severe predictive errors were rare. Accuracy of hearing loss prediction was not significantly affected by chronologic age. However, all methods produced a substantial (31-67%) proportion of predictive errors in patients with minor, clinically insignificant, tympanometric abnormalities. In children with normal impedance findings, the methods permit reasonably accurate identification of hearing loss, categorization of degree of loss, or prediction of hearing loss in dB.