BACKGROUNDPlacement of tympanostomy tubes is one of the commonest ambulatory procedures performed in the pediatric population. Tympanostomy tube placement has been shown to significantly improve speech and hearing, as well as reduce the rates of effusion and recurrent acute otitis media (AOM). The main indications of tympanostomy tube are recurrent AOM with middle ear effusion, chronic otitis media with effusion (OME), and Eustachian tube (ET) dysfunction. The majority of tympanostomy tubes self-extrude within 6 to 18 months due to the natural epithelial migration of tympanic membrane (TM); tubes that fail to spontaneously extrude for more than 2 years are considered retained and may require manual removal in office or in the operating theatre under general anesthesia. Currently, there are no guidelines for the management of retained tubes in asymptomatic patients. Should they be removed? If so, when? Hence, the purpose of this Triological Best Practice is to examine the current best evidence to determine when should a retained tympanostomy tube be removed in children.