To determine possible selection criteria for ventilation tubes (VTs - grommets), in otitis media with effusion (OME), a randomized trial on 68 children was undertaken. To provide both a baseline predictor and outcome measure in auditory disability, speech-in-noise thresholds were obtained with the IHR-McCormick Automated Toy Test (SiN ATT). Children allocated to surgery (n = 32) and control (n = 36) were followed-up at 3 and 12 months postintervention. Baseline SiN ATT score provided a significant by-treatment interaction in predicting the performance at +3 months, establishing it as an evidence-based indicator. Although average benefits on hearing level score (HL) were also shown, baseline HL was not a valid indicator (no significant interaction). The 40% of the sample with worst baseline SiN experienced high benefit from VTs. In children over 3 years of age, baseline SiN performance can indicate those with OME most likely to benefit from VTs.