This study was designed to describe those indicators for the surgical insertion of pressure-equalization (PE) tubes given highest priority in clinical practice by board-certified otolaryngologists. A questionnaire was mailed to 1000 otolaryngologists practicing in the United States. The respondents rated the importance of 22 items on a six-point scale. These items were grouped into four categories: medical history, physical examination, audiologic evaluation, and related factors. The return rate was 52.7%. The five items receiving the highest ratings were "persistence of fluid for 3 or more months per episode," "presence of speech-language delay," "bilateral conductive hearing loss of 20 dB or more," "total number of episodes of otitis media," and "lack of response to suppressive antibiotic therapy."