Background: In New Zealand many more Pacific children fail the school entry hearing screen and experience greater levels of middle ear disease and hearing difficulties than other ethnic groups. However, this disproportionate burden and the long-term impact of Pacific children's hearing difficulties on their health and scholastic achievements is largely unknown. Objectives: The proposed research will investigate middle ear status, hearing sensitivity and auditory processing in 11 year-old Pacific children. Prevalence estimates will be determined and linked to current and past demographic, social and environmental factors and learning, behavioural and health outcomes. Principal methodologies: Utilising an existing cohort study of 1,376 Pacific families measured over multiple waves, this study will assess children's hearing using established diagnostic audiological standards and relate outcomes to longitudinally collected standardised measures. Potential health outcomes/impact: Results will inform evidence-based interventions and policies aimed at reducing health inequalities. Participants with hearing impairments will be offered specialist treatment.