Persistent middle ear effusion is a common cause of hearing impairment and remains underdiagnosed, particularly among younger children. Detection can be improved by adequate follow-up of otitis media. Decisions on management need to take into account the child's age, duration and severity of illness, degree of hearing impairment, and any evidence of learning difficulties. There is no definitive cure but both medical and surgical treatments may improve outcome. With increasing evidence that antihistamine-decongestant mixtures are ineffective, there may in the future be a role for antibiotics and steroids.