Otitis media with effusion is the most frequent reason for admission to hospital for surgery in children. There are worldwide differences in the management of the condition. Recent studies have evaluated indications for surgery, surgical treatment methods, outcome measures following surgery and sequelae. The present report defines the increased risk of behavioural problems in pre-school children with persistent disease. Factors affecting the outcome of surgery with ventilation tubes are discussed. Assessment is made of the complications due to the disease and those resulting from treatment with ventilation tubes. Finally, a review is made of the various international guidelines for the management of persistent disease as a basis for good clinical practice.