Adenoid hypertrophy is a significant cause of childhood morbidity. The enlarged adenoid leads to mouth breathing, snoring, sleep apnea, hyponasality, sinusitis, otitis media with effusion (OME), and abnormal facial development.(1) (Middle ear evaluation) Nasopharyngeal obstruction due to adenoid hypertrophy can directly obstruct the pharyngeal ostia of the auditory tube, 2 mechanical obstruction of the Eustachian tube may be an important factor for the onset of OME. 3 However, recurrent or chronic infection in adenoids without obstructive hypertrophy can also manifest as recurrent acute otitis media, persistent OME supports the theory that adenoids are a reservoir of pathogenic organisms leading to tubal edema and malfunction. 4 OME is a highly concomitant disease in young children with adenoid hypertrophy. However, young children are unable to express the symptoms of hearing loss or parents pay less attention to the child's change in hearing; some of them with adenoid hypertrophy have ME despite not complaining of hearing loss, which may be overlooked if careful procedures for evaluation of middle ear function are not performed. More information is available about the influence of enlarged adenoids on tympanometry. In this article, we investigated the effects of adenoid enlargement on middle ear pressure and the diagnostic efficacy of tympanogram to detect OME in children, and thus recommend the evaluation of essential middle ear functions in young patients with hypertrophy adenoid. Materials and methods This prospective study was approved by the hospital research ethics committee and written informed consent was obtained from the subjects. This study was performed on all 56 cases of positive diagnosis... half of the paper... could rule out MEE. However, 6 ears in which tympanic pressure was less than −200 daPa correctly predicted the presence of MEE in our study. Furthermore, the tympanogram with type C tracing without acoustic stapedius reflex may have a MEE similar to our results. One should pay close attention and be aware of the possible development of hearing loss in adenoid hypertrophy in young children even without parental suspicion of hearing impairment. It is important to perform middle ear examination and tympanometer for adenoid hypertrophy before surgery. If preoperative hearing level assessment is not performed without informing parents, this may lead to unnecessary medical disputes. Otoscopy and tympanometry can make a more accurate diagnosis of pediatric OME in children with adenoid hypertrophy with/without parental suspicion of hearing impairment.