Mamikunian and Stankiewicz of Loyola University, Maywood, Ill, reported their experience with prolonged tympanostomy tubes at the recent meeting of the American Academy of Otolaryngology–Head and Neck Surgery in Washington, DC. Their report emphasized that large, flanged tympanostomy tubes have a significant incidence of complications, most notably, the development of large perforations. This occurred in 64% of the ears with Goode tubes. They reviewed tubes that were placed over a two-year period from 1985 to 1987. There were 240 patients studied, of whom 35 had tubes that required removal after 24 months. Of these, 87% healed and all small, flanged tubes were included among these. Management included removing all of the tubes, both large and small, after two years with paper patch and subsequent tympanoplasty required in some cases. The authors' conclusions were that most tubes do not need to stay in place for over two years, and that large,