A chronic dry perforation in a child presents a dilemma with regard to timing of intervention or whether intervention is appropriate at all. Many studies have looked at elements associated with eustachian tube function in hopes of finding prognostic factors. Adenoidectomy has been shown to be very effective in the treatment of chronic and recurrent otitis media. Intuitively, it would seem to play a role in pediatric tympanoplasty; however, no study has thoroughly investigated this issue to date. To evaluate the role of adenoidectomy in pediatric tympanoplasty, we performed a retrospective review of all patients younger than 18 years who had a simple dry perforation and underwent a Wullstein's type I tympanoplasty. Thirty-six patients were identified for review during the 7-year study period. The patients were grouped into those who had previous adenotonsillectomy (n = 12), those who had prior adenoidectomy alone (n = 10), and those who had neither (n = 14). Initial success of tympanoplasty was noted to be high in all three groups. However, at 6-month follow-up, the success for the group who had not had prior adenoidectomy or tonsillectomy dropped dramatically (14.3%), whereas the other two groups maintained success rates in excess of 75% (p = 0.002). This relationship remained fairly constant throughout the 2 years of follow-up. Although our population under study is somewhat small, the results support a potentially advantageous role of adenoidectomy for pediatric tympanoplasty. These results and their implications will be discussed.