The incidence of Otitis media with effusion (OME) in children is high, with a prevalence of 5–10% unilaterally and 20% bilaterally under 6 years of age. It is more common in certain racial groups such as native Americans, Inuit, Aborigines and Maori. OME is generally self-limiting, and so a period of active monitoring for at least 3 months should precede any treatment. Decongestants, antibiotics and antihistamines are of no proven benefit, but intranasal steroid therapy may be effective when there is an underlying rhinitis. Adenoidectomy has been shown to have an additive effect in the resolution of OME when combined with grommets. National Institute for Health and Clinical Excellence guideline CG60 offers specific advice for treating OME in patients with Down syndrome and in patients with cleft lip and palate. Local complications of OME include tympanosclerosis, perforation, ossicular erosion, retraction pocket formation and cholesteatoma.