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Twenty years have now passed since the first tube was placed through the tympanic membrane for middle ear ventilation. In this relatively short period of time, many different ideas for tube design have emerged and are presented. The types of middle ear fluid formation and the relationship of this formation to impaired eustachian tube function are discussed. The main indication for indwelling tubes is chronic secretory otitis media with effusion which fails to respond to conservative treatment; however, indications have been expanded with continued experience. The complications associated with the use of middle ear ventilation tubes are presented. Five years' experience using ventilation tubes in 1,460 ears is reported. Conclusions are based on data compiled from this study.

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