Objective To assess the effectiveness and safety of adenoidectomy on otitis media with effusion (OME) in children. Methods Electronic databases were searched including Medline (1966-2001), EMbase (1974-2001), the Cochrane Controlled Trials Register (CCTR), Chinese Biomedical Database (CBM, 1989-2001). Five Chinese otolaryngology journals were handsearched. References of eligible studies were also screened for inclusion. Selection criteria were restricted to randomized controlled trials comparing adenoidectomy with other treatments in patients with OME in children. At least two reviewers independently assessed trial quality and extracted data. RevMan 4.1 was used for statistical analysis. Results Of the 248 literatures identified, 13 trials with 1 430 patients were eligible and were included in the systematic review. Overall, the methodological quality of the included trials was high, all from developed countries. None of the trials showed that the effects of adenoidectomy better than those of myringotomy and no treatments for OME in children. Four trials comparing adenoidectomy with grommets showed that the effects of grommets were better than those of adenoidectomy. Ten trials described post-surgical bleeding, velopharyngeal incompetence and nasopharyngeal stenosis. Conclusions At present, there is no evidence to either ascertain that adenoidectomy is better than other treatments for OME, or to suggest which type of surgery is the most effective one. Current trials indicate that early administration of adenoidectomy concomitant with grommets might be the most appropriate therapy for OME in children who fail to response to drug treatment, if multiple risk factors exist.