Otitis media with effusion (OME), also known as glue ear, is a common cause of hearing loss in children. Most cases resolve spontaneously within three months. Early and proper management of OME can help avoid hearing and speech impairment that can result in development delay in children. Tympanostomy tube is usually recommended as treatment of choice in children with hearing loss due to persistent glue ear after three months. The authors’ objective was to evaluate the efficacy of pharmacological therapy in the management of OME. The authors did a comprehensive systematic literature review on PubMed and Japan Medical Abstracts Society Database. They included 18 articles which were either meta-analysis, randomised controlled trials, systematic review or review only. Retrospective studies were excluded. The drug therapies evaluated were carbocysteine, antihistamines, leukotriene receptor antagonist and steroid nasal spray for OME. The authors’ analysis of the included studies recommended that there was no convincing evidence for the efficacy of carbocysteine, antihistamines and leukotriene receptor antagonist in the management of OME. They suggested that there was some evidence to support the use of intranasal steroids for longer than one month in children with OME. This, however, is in contradiction with latest guidance from the American Academy of Otolaryngology (2016), National Institute for Health and Care Excellence (NICE, 2008) and Cochrane database systematic review (2011). It is difficult to recommend intranasal steroid therapy in the management of glue ear based on one RCT and one comparative study when there is strong recommendation against its use in major guidelines and many studies. Further robust studies are required to evaluate efficacy of intranasal steroid in OME. As the guidelines are due to be updated, it would be interesting to see if these recent studies will impact on the guidelines’ recommendations.