Background: otitis media with effusion is common in children and the treatment is still controversial issue. Objective: this study aimed to evaluate the role of topical nasal steroid in treatment of otitis media with effusion   in children. Patients and Method: this was a systematic review of the literature to collect data through searching the Medoline data base (www.pubmed .com) until March 2017 concerning the effectiveness of topical nasal steroids in treatment of otitis media with effusion in children using the different keywords in different combination. Results: meta analysis by relative risk for persistence of OME of 0.551 with 95% CI of 0.314 to 0.966 , meta analysis by risk difference for persistence of OME  of -0.229  with a 95% CI of -0.569 to -0.030  and meta analysis  by odds ratio for persistence of  OME of 0.214 with a 95%  CI  of  0.049 to 0.936, which was statistically significant favoring topical steroid over control . Conclusion : topical nasal steroid is an effective treatment for otitis media with effusion without the complications of oral steroid , nasal steroid spray can be used for longer period, with much greater safety. It can also be helpful in controlling nasal allergy and the adenoid size, which are contributing factors in developing and recurring otitis media with effusion.