An association between otitis media with effusion and phonological impairment has long been recognized. Many questions have gone unanswered, however, such as why large numbers of children who experience early persistent otitis media do not present phonological deficits, and what specific measures might facilitate therapy for those who do. This article first reviews problems faced by researchers and then summarizes currently established findings concerning otitis media and its effects on phonological acquisition. Professionals are warned neither to ignore nor exaggerate the possible influence of a history of otitis media on a child's phonological deficits.