This study was performed to examine the relationship between the pre‐operative radiographic platal airway and no peak‐peak tympanometric conversion 1 yr following adenoidectomy, adenotonsillectomy or no pharyngeal surgery performed for otitis media with effusion. A relationship between the airway in children with otitis media with effusion and matched controls is described and this is used to analyse tympanometric change in 3 airway size groups. No peak‐peak conversion was significantly greater following adenoidectomy or adenotonsillectomy compared with no pharyngeal surgery in those with small airways and tonsillectomy conferred with no additional benefit. Adenoidectomy with or without tonsillectomy is probably best avoided in children with large radiographic palatal airway measurements when planning surgical treatment for established disease, although this may ultimately be related to age at oper