OBJECTIVE: This is a study of whether there are any long-term differences in academic achievements between children with and without observed or treated middle ear disease in a population with a stable long-standing treatment policy. METHODS: A birth cohort of 2156 children was previously studied through a questionnaire to the parents at 4 years of age, follow-up after audiometric screening at 4, 7, 11 and 14 years of age, and study of records from all Ear, Nose and Throats departments in the area; 2095 of these still lived in the area and received academic grades on leaving the ninth year of the state school system. We have compared these grades, and the choice of high school course for children with different experiences of otitis media. RESULTS: A history of treatment for bilateral secretory otitis media was correlated to minor group difference in the mean of grades, but not to any significant difference in the individual grades or in the choice of further studies. Having many episodes of acute otitis before the age of four was uncorrelated to lower grades and to less tendency to continue with theoretical studies. CONCLUSIONS: No harmful effect of middle ear disease could be shown in a large sample, suggesting that Swedish children do not suffer long-term effects on learning from otitis media.