Secretory otitis media is a frequent occurrence in atopic individuals with upper-respiratory tract allergy. An analysis of data from 512 patients with allergy and secretory otitis media, as well as review of the pertinent literature, indicates that this is a disease process wherein no single causative factor consistently can be implicated, that it likely is often a reaction pattern from multiple causes, but an underlying diathesis to allergy would be high on the list as a predisposing or etiologic factor. Data in this report show that no single method of treatment is consistently effective, but best results are obtained only when one identifies, treats, or removes the specific etiologic factors. Failure to recognize the allergic quantum and institute proper therapy early in this disease process likely explains many therapeutic failures and subsequent frequent and serious complications.