The purpose of this study was to estimate the total costs of otitis media (OM) from a societal perspective using a prevalence-based approach to estimate disease related costs for Canadians with OM in 1994. Direct expenditures attributable to OM associated with hospitals, other institutions, physicians, other health professionals, drugs, research and other components of care were assessed, along with estimates of lost productivity due to illness and the workloss of caregivers. The total costs of OM for Canadians were $611.0 million in 1994, with direct and indirect cost components at $470.7 million and $140.3 million, respectively. Over 70% of total OM costs were attributed to children aged 14 years and under ($428.4 million), with direct and indirect costs being $334.1 million and $94.3 million, respectively. This study highlights the scope and magnitude of the economic consequences of OM. The costs calculated may be used to provide guidance in the setting of priorities for research and prevention activities.