1 AIM OF THE STUDY: To document clinical profile (presenting manifestation, hearing assessment) of persistent OME with hearing impairment in children. To compare the improvement in hearing after non surgical versus adenoidectomy with bilateral tympanostomy done in a single sitting. METHODS  and MATERIALS : This prospective study was carried out in the department of otorhinolarynology, Tanjore Medical College . The study period was from January 2010  to May 2011. 60 children diagnosed with OME and persistent hearing impairment in the age group of 5 – 12 years were  studied prospectively. History, otoscopy, tympanometry, acoustic reflexometry and pure tone audiometry findings were recorded before treatment and followed up  at 2nd month and 6th month after randomly alloting  the children into 2 Groups – A and B each consisting of sample size of 30 and giving a Non surgical management to Group A and surgical management to Group B. RESULTS:The mean age at presentation was 8.06 (±2.25) years. 85% of patients had bilateral hearing impairment and 72 % of patients had symptoms of adenoid hypertrophy at presentation. Abnormal findings were noted in 90%, 90%, 94% of ear examination on pneumatic otoscopy, tympanometry, non pneumatic otoscopy and acoustic reflexometry respectively. CONCLUSIONS: Bilateral hearing impairment, symptoms of adenoid hypertrophy, significant hearing impairment (≥ 20dB), abnormal findings on otoscopy and tympanometry were present in more than 60% of children presenting with OME and hearing impairment. In our study, Medical  management ( Group A ): 35% of children in Group A showed improvement for a short duration with recurrence associated with hearing impairment. In our study surgical modality of management in the form of adenoidectomy with bilateral tympanostomy done in a single sitting was found to improve hearing significantly better than Medical management , without major complications.