Secretory otitis media is the most common cause of hearing loss in children, and refers to fluid accumulation in the middle ear without acute inflammation (e.g., fever, earache). Since there is no obvious discomfort, children seldom come forward to seek medical attention, but it is mostly found during routine physical examinations at school and kindergarten. Secretory otitis media causes mild to moderate conductive hearing loss, which can lead to inattention, poor academic performance, and even speech and language developmental disorders. Our current hearing screening system for 0-6 year olds can better detect this insidious onset of the disease. Therefore, parents are reminded to visit the ENT department when their child’s ears “don’t pass” during a routine physical examination. The culprit of secretory otitis media is actually the eustachian tube, a natural tube that connects the ear to the nose. For children with recurrent colds, chronic nasal congestion, heavy nasal sounds, snoring, and open mouth breathing, they may be considered “at risk” for otitis media. For children with congenital cleft palate (regardless of whether the cleft is surgically repaired or not) or Down’s syndrome, parents should pay attention to their hearing condition for the rest of their lives because of the indirect effect of the congenital defect on the ear. Of course, having a secretory otitis media is not terrible, because 80% of these “middle ear effusions” (without congenital defects such as cleft palate or Down’s syndrome) can be absorbed on their own in about 3 months, and parents need to follow up at intervals of 1-3 months. The other 20% of children who do not absorb the fluid require surgery to restore their hearing. The main surgical procedures are tympanotomy and/or adenoidectomy. However, there is a new non-invasive treatment technique that can be considered for children who, even after these two procedures, will have a recurrence of secretory otitis media after removal of the tympanic tube. —- balloon dilation of the eustachian tube. Tympanic tube placement and its complications Tympanic tube placement is a relatively minor procedure, but the child needs to be done under general anesthesia. It is performed by microscopically incising the eardrum, aspirating secretions from the middle ear, and placing a ventilation tube to improve middle ear ventilation and hearing. After the tube is placed, the first review is usually performed 2-4 weeks after the procedure, including hearing, the status of the tube placement (position, presence of blockage, prolapse, and meatus), and the condition of the tympanic membrane. The tubes are then reviewed every 3 months and removed on an outpatient basis between 6 months and 2 years after surgery. Follow-up after removal is required until healing of the perforation after tube removal. There are two types of complications after tympanic tube placement: short-term and long-term. Short-term complications include ear pus, blockage of the tube, granulation, premature detachment formation, and fall into the middle ear. Ear drainage is the most common, occurring in 26% of children, and usually resolves with topical antibiotic drops for 7-10 days. Blockage of the placement, granulation, and premature prolapse may lead to recurrence of secretory otitis media and the possibility of secondary surgery. Long-term complications include: calcified tympanic membrane, tympanic membrane perforation, and effects on hearing. Calcified tympanic membrane, also known as tympanosclerosis, does not affect hearing or increase the chance of middle ear infection and does not require treatment. The incidence of tympanic membrane perforation is about 1-2%, and tympanic membrane repair surgery may be considered for those who do not heal for more than 1 year. Hearing loss due to tube placement is mainly at low frequencies, about 1-2 dB, and can be ignored.