Objective: Otitis media (OM) management involves both primary and specialist health care. The present study used data on general practitioner (GP) referrals to estimate the proportion of children with OM referred from primary to specialist care, study variation in referral pattern and factors that influence GP behaviour.Methods: Data on GPs view on collaborative aspects of specialist health care was collected in a cross-sectional questionnaire survey among all Norwegian GPs in 2004 (N=1633). The outcome of interest was referral routines for OM at first visit and at follow-up.Results: Mean referral for OM was 22%, most commonly at follow-up visit. 27% of children with OM were sent to ear, nose and throat (ENT) departments and 73% to practicing otolaryngologists. Variation in referral pattern among GPs was moderate. GPs with specialty in general medicine had 6% fewer referrals. Separate analysis on referral to practicing otolaryngologists showed that GP work load and availability to practicing specialists increased referral, whereas availability to hospital services reduced the probability. Conclusion: In Norway, OM management mainly takes place in primary care. Completed specialty in general medicine reduces referrals. We suggest that learning groups may contribute to update knowledge in primary care and fewer referrals to specialists. Also, non-medical factors seem to influence referral behavior in general practice.