The majority of ears affected by otitis media with effusion recover, but whether these recoveries are assisted by noninvasive therapies is not yet established. What is known is that some middle ears affected by otitis media with effusion will eventually develop permanent structural and functional defects in spite of surgical intervention. The role of medications and the arguments for and against adenoidectomy and tympanostomy are reviewed in relation to the author's findings from short- and long-term studies of ears treated surgically.