Pediatricians are familiar with conductive hearing loss, but to many it is synonymous with otitis media of some type. There is a group of children who have anatomic abnormalities of the external or middle ear causing their hearing losses. The records of 565 hearing-impaired children were reviewed, and 54 with non-otitis-related conductive hearing loss were found. Date of birth, degree of loss, diagnosis or presence of any associated abnormalities, and ages of confirmation and intervention were studied. There were 22 children with microtia, 14 with abnormalities of the external auditory canal and normal pinnae, 15 with obvious dysmorphic features including 9 who had syndromes well known to be associated with hearing abnormalities, and only 3 who had isolated hearing loss. Despite all these clues, hearing loss was diagnosed in only 10 children (excluding those with bilateral microtia) before 12 months of age although their average hearing loss was 45 dB. It is important for the primary care provider to recognize these children as early as possible as their loss is permanent and almost always more severe than that seen in otitis.