Paper patch myringoplasties are commonly performed in children at the time of ventilation tube removal, yet no series documenting their efficacy appears in the otolaryngology literature. Over an 18-month period at the Children's Hospital of Philadelphia (Pa), 163 ventilation tube removals were performed on 131 children aged 1 to 18 years. In 95 of these ears, a paper patch myringoplasty was performed after tube removal. No significant difference (87% vs 85%) in the overall healing rate at 6 months was shown between these two groups. An analysis of the variables potentially affecting outcome revealed that healing following simple tube removal was influenced by the frequency of tube placement and by tube size. Paper patch myringoplasty significantly improved outcome (93% vs 61%) in ears with more than three previous tube placements.