Introduction: Local community based epidemiological data on hearing loss of school children in Egypt are virtually scanty. Therefore, screening for hearing impairment in this age is crucial for early identification and management of cases. Objective: This work represents a pilot study to estimate the prevalence of hearing loss and / or middle ear disease in a representative sample of primary school children in Cairo. Methods: Sample included in the study was 350 children of both sexes aged 6 - 12 years. They were screened by otoscopy, pure tone audiometry and tympanometry. Results: The prevalence of hearing loss in the studied sample was 18.9%, while middle ear abnormalities were reported in 22% Hearing loss was significantly observed in the young age group (6-9 years) but was unrelated to sex. TM abnormalities were detected in 81 children (23.1%) and found to be significantly associated to abnormal TM mobility and the younger age group (P< 0.01). Conductive HL was detected in a higher percentage (75.8%) of children than SNHL (16.6%) and mixed HL (7.6%). In either type more than 80% of these children had mild or moderate degree of hearing loss. Conclusion: The high prevalence of HL in these children requires implementation of screening programs for hearing loss as a part of pre-school examination program in primary schools to guarantee early identification and effective intervention for the children affected.