ObjectiveWe previously described the use of anterior subannular T-tubes (n = 20) for long-term middle ear ventilation. In the current study, we examine a larger patient population (n = 38) and a longer follow-up interval (average >2 years) to evaluate the efficacy and safety of anterior subannular tympanostomy.Study DesignRetrospective nonrandomized case review.SettingTertiary referral hospital.PatientsOur series consisted of 38 consecutive patients with a diagnosis of eustachian tube dysfunction, adhesive otitis media, or chronic otitis media with a perforation who underwent a tympanoplasty.InterventionA subannular T-tube was placed anteriorly at the time of tympanoplasty to provide long-term middle ear ventilation.Main Outcome MeasuresThe main outcomes of this study are tube position, tube patency, and middle ear ventilation. In addition, hearing was evaluated both preoperatively and postoperatively and any complications were noted.ResultsThere were 38 patients and 38 ears that received an anterior subannular T-tube at the time of tympanoplasty. The study group consisted of 24 female patients and 14 male patents with a median age of 36 years (range, 10–75 yr). All 38 patients had eustachian tube dysfunction, 22 had adhesive otitis media, 23 had chronic otitis media, 13 had a cholesteatoma, 11 had tympanic membrane perforations, and 3 patients had a cleft palate. All patients underwent tympanoplasty. Eighteen patients had a concomitant ossiculoplasty and 7 had a mastoidectomy. Follow-up ranged from 1 month to 48 months (average, 26 mo). Three tubes had extruded within 2 years, in 1 case resulting in a persistent perforation. Postoperative complications included 1 patient with a partially extruded prosthesis, 2 patients with tipped prosthesis and persistent tympanic membrane retraction, and 1 patient with a plugged tube. All other tubes were patent and showed no evidence of migration. Furthermore, there were no cases of anterior canal blunting or ingrowth of epithelium around the tube.ConclusionAnterior subannular tympanostomy is a safe and effective method for long-term middle ear ventilation in patients with chronic eustachian tube dysfunction.