Otitis media with effusion is the leading cause of hearing loss in children. The pathogenesis of this disease process continues to be controversial. Diagnosis requires precise otoscopic evaluation coupled with audiometric investigation. Therapy has traditionally included medical and surgical regimens. Recent findings indicate that some basic changes may be required in both these therapeutic avenues. Aggressive therapeutic intervention may be required in patients presenting with complications of otitis media with effusion. Available information strongly indicates that a more intensified research effort must be undertaken to better identify and treat this difficult disease process.