Repeated use of antibiotics and decongestants does not always result in the permanent removal of adenoidectomy fluid in children and adults. As a result, more intervention may be necessary. This usually involves a myringotomy and the insertion of pressure equalization tubes. The procedure is normally performed during the day, with the patient arriving early in the morning and leaving later that day. The surgeon makes a small incision in the eardrum and drains the fluid while the child is asleep. After that, a thin plastic tube is inserted into the incision to let air into the middle ear, allowing the fluid to dissipate and prevent it from collecting. This operation can be performed in the office under local anesthetic on a willing adult.

The tube will stay in the eardrum for a different amount of time, ranging from three to twelve months on average. The tube will eventually be ejected and the eardrum incision will seal in many youngsters. The ear will have had time to heal from the chronic inflammatory state, and the Eustachian tube will have developed sufficiently to function normally. In order to aid normal Eustachian function, an adenoidectomy (removal of the adenoid tissue close to the Eustachian tube) is performed in conjunction with the myringotomy in some patients. In other people, an allergy examination may be required to assist alleviate the condition, especially if it recurs.