Abstract To evaluate the effectiveness of using topical nasal steroids versus oral steroids in the treatment of otitis media with effusion (OME) in children. One hundred (100) patients were included in the study, they were divided into two equal groups, group A received intranasal mometasone furoate spray once daily for 6 weeks, and group B received oral steroids in tapering doses for 6 weeks, plus systemic antibiotics, and nasal decongestants for both groups, tympanogram was done every 2 weeks for all patients. Highly significant improvement (P 0.05) in improvement between the two groups. Both topical intranasal and oral steroids are effective medical therapy in the treatment of OME in children with no significant difference between the two methods.