The most common question asked by parents of small children online is how to treat otitis media and whether to place tubes or not. This is a simple question, but not a simple one to answer, as each child’s situation is different and should be considered on a case-by-case basis. Generally speaking, there is no need to be overly nervous about the discovery of secretory otitis media, as it is a common disease in children, especially in the fall and winter, and most of them can be cured. In the case of newly discovered secretory otitis media, we usually treat it for half a month (anti-inflammatory and nasal drip) and then stop the medication for observation. Although otitis media is an uncomplicated disease, there are different conditions that vary from person to person, so the indications for tympanic tube placement for otitis media with secretion are listed below. 1. Chronic exudative otitis media, where conservative drug therapy is ineffective, with bilateral onset of disease lasting longer than 3 months, and unilateral onset of disease lasting longer than 6 months. (8) Syndromes (e.g., Down syndrome) or craniofacial disorders (9) Blindness or uncorrectable visual defects (10) Cleft palate with or without associated syndromes (11) Developmental delay 2. Recurrent acute otitis media especially if antibiotics are not effective History of more than three episodes in the past 6 months History of more than four episodes in the past year, with recent episodes 3. Recurrent exudative otitis media Each episode is not sufficient for chronic criteria, but the cumulative duration of each episode is long (6-12 months) 4. Complicated purulent otitis media found or suspected Tympanic membrane puncture or tube placement after tympanotomy can facilitate middle ear fluid flow and improve ventilation 5. Eustachian tube malfunction Persistent or recurrent episodes with poor drug effectiveness, with or without middle ear effusion Presence of tinnitus, hearing loss (usually fluctuating), balance disturbance, or vertigo manifestations Requires hyperbaric oxygen therapy