"Description: Percentage of patients aged 2 months through 12 years with a diagnosis of OME who were not prescribed topical intranasal corticosteroids Rationale: OME usually resolves spontaneously with indications for therapy only if the condition is persistent and clinically significant benefits can be achieved. In children aged 4 to 11 years, there was no difference in the resolution of effusion or hearing loss over 3 months between children treated with nasal mometasone or placebo; in fact, there was an economic disadvantage in the group treated with mometasone, considering the high rate of spontaneous resolution in the placebo group. Furthermore, 7% to 22% of study group patients experienced minor adverse effects. The purpose of the corresponding guideline action statement is to reduce ineffective and potentially harmful medical interventions in OME when there is no long-term benefit to be gained in the majority of cases. Medications have long been used to treat OME, with the dual goals of improving QOL and avoiding more invasive surgical interventions. Both the 1994 guidelines and the 2004 guidelines determined that the weight of evidence did not support the routine use of steroids (either oral or intranasal), antimicrobials, antihistamines, or decongestants as therapy for OME. Evidence: STATEMENT 8a. STEROIDS: Clinicians should recommend against using intranasal steroids or systemic steroids for treating OME. Strong recommendation against based on systematic review of RCTs and preponderance of harm over benefit. Clinical Practice Guideline: Otitis Media with Effusion (Update). Rosenfeld RM et al. Otolaryngoly Head Neck Surg. (2016)"