Objective: To investigate the impact of myringotomy tubes (MTs) on outcomes for pediatric cochlear implant (CI) recipients. Design: Retrospective case-control chart review. Setting: Tertiary care pediatric hospital. Patients: Sixty-two patients received an MT before CI (mean [SD] age at initial CI, 3.20 [2.45] years). Seventy-eight ears received CIs and MTs. Intervention: The MTs were removed and allowed to extrude before CI (59% [n=46]) or kept in place until CI (41% [n=32]). Main Outcome Measures: Otorrhea, persistent tympanic membrane (TM) perforation, and need for additional procedures were recorded. Statistical analysis was performed with the Fisher exact test. Results: Forty ears (51%) required more than 1 set of MTs. Ten ears (22%) in which the MTs were removed before CI required a separate MT after CI compared with 6 ears (19%) in which the MTs remained in place until CI (P=.78). The MTs that were present during CI were either removed with myringoplasty (31% [n=10]) or retained after surgery (69% [n=22]). All TMs in which the tubes were removed before or during CI healed. There were 3 persistent TM perforations that required surgical treatment. There were no cases of meningitis and no removals of CIs because of infection. Conclusions: Myringotomy tubes do not appear to adversely affect the final outcomes of pediatric CI recipients and can be managed similarly to MTs in other otitis media-prone children. They may be left in place in children who continue to experience recurrent acute otitis media or removed in children who no longer need them. ©2010 American Medical Association. All rights reserved.