Introduction: Otitis media with effusion (OME) is defined as an effusion in the middle ear without signs and symptoms of an acute infection.

Objectives: To evaluate the efficacy of nasal steroids in OME in children by compared with oral steroids and with nasal saline spray.

Patients and Methods: This study included 60 children with bilateral OME. The children were divided into three equal groups; group A, 20 children received mometasone furoate nasal spray. In group B, 20 children received oral prednisolone. In group C, twenty children received hypertonic seawater nasal spray. Clinical follow-up was done once per week for four weeks, at the end of treatment, and then monthly for three months. Otoscopic examination, audiological evaluation was done before treatment for each group and repeated at 3,6 months after treatment.

Results: A highly significant difference between systemic or topical nasal steroid and hypertonic seawater nasal spray was detected regarding symptoms improvement, clinical examination, adenoids hypertrophy, and hearing condition. The difference between systemic and topical steroids was statistically insignificant. Conclusion: Nasal steroid spray is an effective treatment for OME, similar to systemic steroid but without the hazard of corticosteroids.