Objectives: to estimate a period for grommet tube removal in the age category of 4-8 years that is associated with the highest rate of success and the least rate of recurrence. Design: prospective randomised study Setting: Benha University Hospital and 3 private clinics. Patients: 500 children, 4-8 years old, diagnosed as having chronic SOM managed by Shapered grommet tubes insertion, were randomly allocated into 4 groups according to the planned timing of tube removal; after 6 months (group A), 12 months (group B), 18 months (group C) and 24 months (group D). Patients were followed-up for 18 months after tube removal. Main outcome measures: middle ear pressure, perforation healing time, hearing improvement and recurrence, in relation to time of tube removal Results: 541 ears in 316 children were analysed. Group A showed higher rate of recurrence of SOM after 18 months post-tube removal while it showed low residual perforation rate. Group C and D showed higher residual perforation rates comparing to the other groups at the end of the follow up period. Recurrence of SOM was minimal in group C and D. Group B showed low rate of recurrence comparable to group C and D and also showed low rate of residual perforation comparable to group A. Conclusions: Removing grommet tubes by the 12th month postoperative is recommended in cases of secretory otitis media in the age group of 4- 8 years as it achieved low recurrence rate of SOM and low residual perforation rate compared to earlier or later removal.