Background:Otitis media with effusion is one of the most common chronic otological conditions and the most common cause of conductive hearing loss in the pediatric population. Ventilation tubes insertion with or without adenoidectomy is considered as a standard surgical procedure. Objective:this study aimed to compare the efficacy and the complications of adenoidectomy with myringotomy in comparison with adenoidectomy and ventilation tube insertion in management of otitis media with effusion. Patients and Methods: this was a prospective study carried out between October 2017 to October 2018 (One year). The study included 60 cases diagnosed with persistent otitis media with effusion due to adenoid enlargement and they were categorized randomly into two groups (30 cases per each). Group I underwent myringotomy alone with adenoidectomy and group II underwent myringotomy with ventilation tube insertion with adenoidectomy. All patients were subjected to full ENT examination, tympanometry and hearing evaluation. Patients were followed up (After myringotomy healing, at one month and 3 months after healing) for 3 months after tube extrusion or myringotomy closure. Postoperative evaluation was done for all patients and complications were assessed. Results: the mean healing time was significantly longer in children who underwent adenoidectomy with ventilation tube (Group II) compared to patients of group I, (p<0.001) (28.5 vs. 2.2 weeks). The number of cases with OME recurrence after 3 months of healed myringotomy were significantly higher in group I (18 ears, 30.0%) compared to group II (6 ears, 10.0%), (p<0.006). Postoperative tympanogram was improved in both groups but, it was significantly improved in the group who underwent adenoidectomy with ventilation tube (Group II) compared to the group who underwent adenoidectomy with myringotomy only at all follow up intervals (p=0.015, 0.002, 0.022), respectively. The incidence of some postoperative complications such as otorrhea and tympanic sclerosis was significantly higher in group II (p=0.024 for otorrhea and p<0.001 for tympanic sclerosis). Conclusion: both used procedures were effective in the treatment of OME in children, but adenoidectomy with ventilation tube insertion was significantly better in improving tympanogram and reducing OME recurrence, while, it may increase the incidence of some complications. Further studies are warranted with larger number of cases and longer follow-up period to confirm these results.