Objective： To investigate the effect of size and location of adenoid tissue on hearing threshold in children with otitis media with effusion. Methods： A total of 94 children (152 ears) over 4 years old diagnosed as otitis media with effusion were included in this study. Adenoids were examined by electronic nasopharyngoscopy. Four adenoid size groups were determined according to the percentage of choanal closure. According to the adjoint relationship between the adenoid tissue and the torus tubarius, the subjects were divided into three groups: A, B and C. In group A, the adenoid tissue keeps a certain distance from the torus tubarius. In group B, the adenoid tissue was in contact with the torus tubarius, without covering the pharyngeal opening of auditory tube. In group C, the adenoid tissue covered the pharyngeal opening of auditory tube completely. Bone and air conduction thresholds were determined using standard procedures. We used pure tone audiometry to test the bone and air conduction thresholds, and calculated the average hearing threshold. The effect of size and location of adenoid tissue on hearing threshold in children with otitis media with effusion was investigated by statistical analysis. Results： There was no significant correlation between the size and location of adenoid tissue and the hearing threshold in children with otitis media with effusion (P>0.05). The hearing threshold of children with type B tympanogram was significantly higher than that of children with type C tympanogram, and the difference was statistically significant(P < 0.001). Whether grouped by adenoid size or location, there was no significant difference in the proportion of ears with type B or C tympanogram among the groups. Conclusion： We conclude that the hearing threshold and duration of otitis media with effusion in children are not affected by the size and location of adenoid tissue. We recommend caution before deciding on adenoidectomy for children over 4 years of age with otitis media with effusion. Unless there is a clear indication of adenoidectomy, such as nasal congestion or snoring or chronic adenoidosis, surgery should not be chosen solely on the basis of the degree of adenoid hypertrophy and the extent of obstruction to the eustachian tube.