Objective To investigate the effect of size and location of adenoid tissue on the hearing threshold in children with otitis media with effusion (OME). Methods A total of 94 children (152 ears) over 4 years old with clinical diagnosis of OME were included in this study. The size and location of their adenoids were examined using electronic nasopharyngoscopy. According to the degree of adenoids causing choanal obstruction from small to large, the children were divided into 4 groups. group 1 (n=25, 43 ears), group 2 (n=31, 47 ears), group 3 (n=27, 44 ears), and group 4 (n=11, 18 ears). According to the relationship between the adenoid tissue and the torus tubarius of the eustachian tube, the children were divided into 3 groups, including 41 cases (62 ears) in group A, 34 cases (54 ears) in group B and 19 cases (36 ears) in group C. Bone and air conduction thresholds were determined by pure tone audiometry, and their average values were calculated at four frequencies of 0.5, 1, 2 and 4 kHz. The effect of the size and location of adenoid tissue on the hearing threshold in children with OME was investigated statistically. Results There was no correlation between the size and location of adenoid tissue and the hearing threshold in children with OME (P>0.05). The average hearing threshold of children with tympanogram type B was significantly higher than that of tympanogram type C (P<0.001). There was no significant difference in the proportion of tympanogram type B or C among the groups according to adenoid size or location (P>0.05).Conclusions The hearing threshold in children with OME is not affected by the size and location of adenoid tissue. Caution should be exercised before adenoidectomy in children over 4 years of age with OME, unless there is a clear indication of adenoidectomy, such as nasal congestion, snoring, or chronic adenoiditis. Otherwise, adenoidectomy should not be based solely on the size of the adenoid and the degree of obstruction to the eustachian tube or the presence of OME in the short term.