Abstract: A ventilation tube is provided for permitting gaseous communication between the middle ear and the outer ear canal of a recipient. The tube is formed of a material that resists extrusion from the tympanic membrane such as titanium or a titanium alloy or others, and includes an outer end portion which is adapted to communicate with the outer ear canal and an inner ear portion adapted to communicate with the middle ear. A pair of spaced apart flanges are mounted respectively on the outer end portion and the inner end portion of the tube. A coating or insert formed of a material that resists tissue adherence such as a fluoroplastic polymer (e.g., Teflon) or others lines at least the portion of the opening in the tube adjacent to the middle ear and the flange on the middle ear side of the tympanic membrane.