This paper examines recent trends in glue ear surgery in Scottish children between 1990 and 1994, using routine National Health Service (NHS) data from all 15 Scottish Health Boards (total population 5,132,400 in 1994, with 1,038,296 aged 0-15). Absolute numbers, rates of glue ear operations, and variation in rates declined between 1990 and 1994 across all Health Boards. The proportion of glue ear operations which included grommet insertion increased. Grommet rates in children declined in those Boards with the highest rates, but increased in Boards with the lowest rates, thereby decreasing the variation in grommet rates across Scottish Health Boards from 3.8- in 1990 to 2.6-fold in 1994. Other operations for glue ear, particularly 'myringotomy and adenoidectomy', varied 20-fold between Health Boards. The proportion of operations performed as day cases increased, but day cases and repeat grommet insertions still showed two-fold variation across Scotland in 1994. Many aspects of surgical management still show variation, and merit further examination by ENT surgeons and Public Health physicians.