Tympanostomy (ventilating) tubes are the most common ambulatory surgery performed on children in the United States. This presentation provides strategies and management paradigms for optimizing outcomes for children with tympanostomy tubes, based on current best evidence and the author’s experience as an international authority in managing otitis media. Topics will include tube selection, perioperative management, office-based insertion, water precautions, tube obstruction, tube granulomas, chronic otorrhea, medialized tubes, and adjuvant adenoidectomy. Emphasis is placed on a patient-centered approach that build upon current practice guidelines and evidence-informed strategies.