Background : Acute otitis media (AOM) is one of the most common childhood infections. The pathogenesis of otitis media is complex. However, Eustachian tube dysfunction stands out as the single most important factor. Since the bony part of the Eustachian tube is located in the temporal bone, the position of this bone may affect its function. Osteopathic practitioners use gentle cranial techniques to evaluate presence of temporal bone dysfunction describe as mobility restriction of this bone. Purpose: To investigate if there is a relationship between temporal bone dysfunction as evaluated by osteopathic practitioners and AOM in young children between 6 and 30 months of age. Methods: Sixty-five children, 6 to 18 month [i.e. months] of age, and without prior history of AOM were included in this prospective cohort study. Baseline potential confounders and temporal bone status were evaluated. Children were followed prospectively during the cold season in Canada (September 2009 to April 2010). Occurrences of AOM as diagnosed by family physicians, blinded to temporal bone status of the child, were recorded. Multi levels logistic regression was used to identify AOM risk factors. Results: Severe temporal bone mobility restriction was identified in 23 children (35 %). Results revealed that 48.3 % of the temporal bone with severe dysfunction and 28.3 % of those without severe dysfunction have experienced at least one AOM episode. Multi levels logistic regression identified the following as statistically significant risk factors for AOM: severe temporal bone dysfunction (OR 4.5, 95 % CI 1.72-11.81, p=0.003) and pacifier use (OR 6.9, 95 % CI 1.88-25.71, p9.005). Age (OR 0.17, 95 % CI 0.07-0.44, p=0.001) is a protective factor.