Aim: High rates of paediatric ear, nose and throat (ENT) surgery persist. Little is known about its impact on health service utilisation. This study investigated whether children who had ENT surgery used more health services prior to surgery (excluding the perisurgery period), and, if so, whether surgery resulted in reduced utilisation. Methods: A retrospective population cohort study of health services use (measured by Medicare claims) by 6239 New South Wales children from the time of their birth in January 1990 until December 1997. We compared: (i) number of claims during the 8-year period for the 359 children who had privately-funded ENT surgery (tonsillectomy, myringotomy or adenoidectomy) with claims made by 5880 children who did not have ENT surgery; and (ii) among children who had surgery: we compared claims made before surgery with those made after surgery. Results: Children who had privately funded ENT surgery (comprising 59% of all paediatric ENT surgery) used significantly more services than other children in total (103.8 claims vs. 57.1 over 8 years) and in each three months of age from birth to eight years, including services for non-ENT-related conditions. Tonsillectomy resulted in a decline in claims, but not to the level of children who did not have surgery. Most children who had myringotomy continued high-level health services use following surgery. Conclusions: High volume health services utilisation is a potential predictor of ENT surgery in this population. These results suggest a need to investigate non-clinical factors that influence service utilisation, which may include higher parental expectations or anxiety regarding their children's health.