Otitis media is a common and costly condition of childhood, with a great potential for cost savings from an effective vaccine. We present a population-based survey of the family burden of otitis media and compare it with another common childhood illness, varicella, for which vaccine prevention is available and cost-effective. We report yearly rates of affected children, complications, medication use, hospitalizations, parental work absences, and use of special sick-child day care in a population of 4557 households containing 9047 children younger than 13 years of age. Of the 9047 children in the sample, 26.1% were affected by otitis media in the year of the study; 68% of children in the second year of life had at least one episode. About one third of families lost workdays due to otitis media in their children, with an overall average loss of about 3 hours per affected child. Compared with the community burden of varicella, otitis media involves a greater total burden in terms of the number of affected children, the number of episodes, physician visits, prescription drugs, hospitalizations, and surgical procedures. Work loss was 3.4 times greater per family with a varicella case, but the number of families affected by otitis media was 3.3 times greater than for varicella, so that the total amount of family work loss was about the same for both illnesses for the year. The community burden of otitis media should be studied in a population-based longitudinal manner that includes parental work loss as well as health care costs to accurately determine the potential cost-benefit of prevention programs.