Background: Otitis media with effusion (OME) which also called glue ear is famous in children. Most of children under four years could have OME, but decline beyond six years of age, medical and surgical treatments are present for OME. Objective: The aim of the current work was to evaluate the impact of early extrusion of grommet tubes on the eustachian tubes of children and whether this necessitates another intervention or not. Subjects and methods This retrospective cohort study included a total of 191 pediatric patients (aged 3 to 14 years old) who suffered from bilateral otitis media with effusion (OME), not responding to medicinal treatment, and undergone myringotomy with Shepard grommet tubes insertion.