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The revised practice guideline 'Otitis media with effusion' from the Dutch College of General Practitioners constitutes a valuable contribution to the discussion regarding the diagnosis and treatment of this condition. A few critical comments can, however, be made. Pneumatic otoscopy and physical examination are considered to be very valuable. However, many general practitioners do not possess either the means or the skill to perform these investigations correctly. Patients with signs of (serious) hearing impairment should in the first place be referred to an otorhinolaryngologist, who can then refer children with proven perceptive hearing loss to a centre for audiology. This practice guideline recommends referral to an otorhinolaryngologist in case of hearing loss of more than 30 dB; according to otorhinolaryngologists this should be 25 dB or more. However, the duration and severity of the symptoms are more important. Speech and language retardation, behavioural problems at school due to hearing impairment and the possible development of an atelectatic tympanum are important reasons for referral. Otorhinolaryngologists also object to the wait-and-see attitude that is recommended in the practice guideline. Since there is no unambiguous evidence regarding the consequences ofotitis media with effusion in the long term, it would seem more reasonable to take the decision whether or not to treat the condition (and if so, when) in consultation with the parents. It is the parents who can best judge whether the child can live with the negative consequences of an untreated otitis media with effusion.