OBJECTIVES: A study was carried out to assess the economic burden associated with complications and/or long -term sequelae of AOM. This pilot study was done to assess feasibility to extend to a larger sample. METHODS: A retrospective patient chart review was performed in one Belgian center to obtain data on medical consumption related to the management of complications/sequelae of AOM. Data were collected for 10-15 years from the first AOM event onwards. Patients were eligible if they were between 10 and 20 years old with minimum 9 years of follow up data available and experienced a complication of AOM. Data on demographics, occurrence and type of complication, management of AOM, complications and sequelae were collected per year. Direct costs were calculated by multiplying each item of resource use with its unit cost (2010 in €) using the Belgian public health care payer’s perspective. Average (SD) yearly cost per patient, average yearly cost pre-complication, average cost during the year of complication, average yearly cost post-complication were calculated.  RESULTS: Twenty-five patients were recruited in this pilot study. Complications were chronic suppurative OM with cholesteatoma, chronic perforation of the tympanic membrane and sensorineural hearing loss. The average yearly cost per patient was €966(SD:1579) with following components; hearing aid devices (€381(SD:1356)), hospitalizations (€298(SD:250)), outpatient procedures (€121(SD:107)), visits (€91 (SD:183)), tests (€48(SD:46)) and drugs (€25(SD:89)). A complication occurred on average 5.3 years (SD: 2.9) after the first AOM event. Average annual cost pre-complication was €232(SD:218), with outpatient procedures as main cost drivers. Average cost of complication per annum was €2808(SD:4827), average yearly cost post-complication was €1593(SD:3366). As from occurrence of complication onwards costs are mainly driven by hospitalizations and hearing aid devices. CONCLUSIONS: Long term complications/sequelae of AOM result in considerable costs for the health care payer, mainly driven by hospitalizations, and hearing aid devices.