In the past decade, deformational plagiocephaly has seen a staggering increase attributed to the Back to Sleep Campaign of April 1992. With this increase, the possible clinical associations need to be fully understood. The anatomic changes seen include ipsilateral occipital flattening, ipsilateral frontal bossing, ipsilateral anterior ear displacement, contralateral occipital bossing, and contralateral frontal flattening [J Craniofac Surg 2004;15:368-372, erratum in J Craniofac Surg 2004;15:705; Fig. l]. Children with deformational plagiocephaly can have malpositioned ears affecting normal drainage of the eustachian tube as it shifts with this deformity. The eustachian tube plays an important role in draining the middle ear. As evidenced by children with cleft palates, structural differences in the anatomy of the middle ear and eustachian tube can result in an increased susceptibility to otitis media. An institutional review board-approved retrospective study was conducted on all patients whose conditions were diagnosed as deformational plagiocephaly from a cleft and craniofacial deformities clinic for a 2-year period. Parents of patients self-reported the number of ear infections on a questionnaire. The questionnaire results were compared to age-matched patient data available from the Center for Disease Control. There were 1259 patients who fit the inclusion criteria for the questionnaire part of the study, and of these, 634 (50.4%) reported at least 1 ear infection by 1 year of age. In addition to the questionnaire, a subset of infants with deformational plagiocephaly up to 1 year of age were administered a tympanogram, to assess the state of the middle ear. There were 124 patients who fit the inclusion criteria for the tympanometry part of the study, and of these 121 had an abnormal tympanogram at 1 or more clinic visits. The questionnaire did not show deformational plagiocephaly to be a significant risk factor for otitis media in our patient population; however, a trend directly correlating otitis media and the severity level of deformational plagiocephaly was observed. Although this trend lacked statistical significance, further studies should explore these differences. Tympanogrametry showed a marked percentage of infants with deformational plagiocephaly to have eustachian tube dysfunction. Future studies will focus on the significance of these findings.