To gain more information about the role of tympanostomy tubes in the treatment of chronic middle ear effusion, the authors conducted a randomized trial that clearly indicated the short-term advantages of combining the insertion of an Armstrong ventilator tube with paracentesis and fluid aspiration over paracentesis and aspiration alone. A retrospective study of the success rate with three types of tympanostomy tubes (Shepard, Armstrong, and Paparella) was also carried out. The Armstrong tube had the highest success rate.