OBJECTIVES: Tympanostomy tube (TT) placement is the most common ambulatory surgery performed on children with otitis media (OM) in the US. Post-TT complications, recurrent tube otorrhea, and recurrent OM require follow-up and treatment; otolaryngologists report that care is often, and inappropriately, sought in the emergency department (ED). The objective is to evaluate ED utilization in pediatric patients with TT. METHODS: Medical insurance claims data for pediatric patients (≤17 years) who underwent TT surgery between 01Jan2010 and 31Dec2013 and had 360 days of continuous enrollment were included. The main endpoint was the proportion of patients with ≥1 ED encounters within 360 days post-TT placement, both all-cause and ear-related ED visits (e.g., for otorrhea, OM, otalgia). Differences between Medicaid-enrolled and commercially insured patients were analyzed. RESULTS: A total of 237,072 patients met the inclusion criteria (88,778 Medicaid and 148,294 commercial)