Early detection of otitis media and adequate treatment in small children prevent from chronic middle ear disease and complications development. The purpose of this article is to determine the role of the noninvasive electro-acoustical examinations in treatment modality selection in prolonged otitis media forms. Impedance audiometry, brainstem evoked response audiometry and registration of otoacoustical emissions were used for early detection of middle ear pathology and for monitoring of children. Monitoring of small children confirmed high rate of otitis media in this age group. Correct interpretation of the diagnostic tests results, analysis of risk factors background and electro-acoustical monitoring present the basis for differentiation between short-duration otitis media forms and prolonged forms. Any modification of impedance audiometry results in a child with risk factors is indication for further electro-acoustical monitoring of middle ear. Prolonged forms of otitis media in children are treated by ear surgery—myringotomy with tympanostomy tube insertion. Post-surgical electro-acoustical monitoring gives the information of middle ear status and function and is useful in prognosis of otitis media evolution. Post-surgical electro-acoustical monitoring showed the advantages of tympanostomy in children especially in modified version.