One hundred and eighty-one children with primary attacks of acute, purulent otitis media with bulging tympanic membranes were treated with antibiotics and nasal decongestants, and in approximately one half of the patients selected by random method, myringotomies were also performed. The only significant difference between the two groups, as judged by resolution of the middle-ear pathology, audiometry, and clinical response, was greater pain relief in a small group in whom there had been severe earache initially. Myringotomies were performed on patients in each group when resolution of the middle-ear pathology failed to occur within a reasonable length of time.