There are two main types of chronic otitis media in children. The "benign" type with a central tympanic membrane perforation may heal spontaneously with conservative management. However, if the central tympanic membrane perforation fails to heal, it should be closed surgically--preferably at the age when the incidence of ear disease in children is lowest. Chronic otitis media with cholesteatoma usually has an attic or marginal perforation and requires surgical treatment to prevent serious complications. The incidence of this disease has been decreasing because of awareness by primary physicians of the importance of prompt treatment and the increase in the practice of inserting ventilation tubes.