Background: Childhood chronic otitis media is a chronic disease of great significance because of its lifelong effects on hearing, language development, educational progress, antisocial outcomes and behaviours. Two common behavioural disorders, namely attention deficit hyperactivity disorder and conduct disorder (externalising disorders), have been linked with childhood chronic otitis media. In addition, caring for children with chronic otitis media and children with externalising disorders has been associated with elevated levels of caregiver strains. There is a dearth of information on the association of childhood chronic otitis media with externalising disorders and psychological distress experienced by their primary caregivers in Nigeria. Aim: The aim of this study was to determine the prevalence of externalising disorders (Attention deficit hyperactivity disorder and conduct disorder) among children aged 9 to 17 years who have chronic otitis media and the association between chronic otitis media and psychological distress in their primary caregivers. Methods: Using a cross-sectional study design, 100 children with chronic otitis media were matched for age with 100 primary/secondary school students (Comparison Group A) and 100 children with other ENT diseases other than chronic otitis media (Comparison Group B) in Kaduna metropolis, Nigeria. The children were aged 9 to 17 years. The Youth Version of the Computerized Diagnostic Interview Schedule for Children, Version 4 (C-DISC IV) was used to assess for the externalising disorders (ADHD and conduct disorder) in the children. Psychological distress in the primary caregivers of all the children was assessed using the twenty-eight item General Health Questionnaire (GHQ - 28). Results: Externalising disorders were present in 12% of the children with chronic otitis media. These were made of 9% attention deficit hyperactivity disorder and 3% conduct disorder. One percent (1%) of the children in Comparison Group B had externalising disorders (attention deficit hyperactivity disorder) but none of the children in Comparison Group A had any externalising disorders. A duration of illness of more than 12 months, presence of bilateral chronic otitis media and the type of treatment were the only variables that showed statistically significant associations with the presence of externalising disorders in the children with chronic otitis media (χ2=10.83, P = 0.001; χ2=5.69, P = 0.013; χ2 = 10.29, P = 0.004 respectively). Fifty-six (56%) of the primary caregivers of children with chronic otitis media had psychological distress compared with 13% primary caregivers of children in the Comparison Group B; the difference was statistically significant (χ2=40.91, P < 0.001). Nine percent (9%) of primary caregivers of children in the Comparison Group A had psychological distress compared with 56% in primary caregivers of children with chronic otitis media (χ2=50.35, P < 0.001). Psychological distress in primary caregivers of children with chronic otitis media was significantly associated with the presence of externalising disorders in the children (χ2=7.040, P = 0.011). Conclusion: Externalising disorders occur commonly among Nigerian children with chronic otitis media and there is associated psychological distress in their primary caregivers. Efforts should be made to establish a system for early identification, referral and management of affected children. Intervention programmes aimed at reducing the stress of caregiving should be implemented