OBJECTIVES: Tympanostomy tube (TT) placement is an established treatment for recurring otitis media (OM), an ear-related condition occurring in ~90% of children by age 4 and posing a significant economic burden, with >$4B USD in annual costs. As limited data documenting economic outcomes in this area exist, this study assessed direct medical costs following TT placement in real-world settings. METHODS: Insurance claims (1/2010-12/2013) of commercially insured and Medicaid-enrolled children (≤17 years) were analyzed. Inclusion criteria included: medical claim for TT placement (CPT code 69436 and/or ICD-9-CM procedure code 20.01), and continuous health plan enrollment for ≥180 days before and ≥360 days following the procedure. Predicted, adjusted medical costs (i.e., total; office and emergency room [ER] visit-related) of ear-related care, among those receiving such care during the 360-day follow-up period, were generated following estimation of multivariable generalized linear regression models. Results were generated overall, as well as stratified by commercially insured and Medicaid-enrolled patients. RESULTS: