Background Ear, Nose and Throat (ENT) primary contact models of care use audiologists as the first triage point for children referred to ENT for middle ear and hearing concerns; and have shown reduced waiting time, improved ENT surgical conversion rates and increased service capacity. This study aimed to investigate ‘safety and quality’ of the model by looking at agreement between audiologists’ and an ENT’s clinical decisions.  Methods We performed an inter-rater agreement study on diagnosis and management decisions made by audiologists and an ENT for 50 children seen in an Australian hospital’s ENT primary contact service, and examined the nature and patterns of disagreements. Results Professionals agreed on at least one site-of-lesion diagnosis for all children (100%) and on the primary management for 74% (Gwet’s AC1 = 0.67). Management disagreements clustered around i) providing ‘watchful waiting’ versus sooner medical opinion (18%), and ii) providing monitoring versus discharge for children with no current symptoms (8%). There were no cases where the audiologist recommended discharge when the ENT recommended further medical opinion. Conclusions Our novel research provides further evidence that Audiologist-led primary contact models for children with middle ear and hearing concerns are safe as well as efficient.