OBJECTIVE: Despite the fact that chronic otitis media with effusion (OME) is an entity with a high prevalence among children, the real effectiveness of most treatments in use nowadays has not been completely established. Based on its natural course, we defend an expectant management as the initial treatment. METHODS: We undertook a review of the available data taking into consideration the natural history, epidemiology and therapeutic options for OME. We looked for a guideline concerning the best treatment for OME in children. RESULTS: The treatment of OME still remains controversial, in spite of many therapeutic options. In children, the best management still seems to be the observation, probably for a period of three to six months. However, interventionist treatment should be done earlier on those patients considered as high risk or in which a problem happened with their development, due to hearing loss secondary to OME. CONCLUSIONS: The understanding of the several factors involved in the pathogenesis of OME, as well as of the features in its evolutive course, encourage the idea of a conservative expectant approach at first or up to the moment in which an interventionist approach (clinical or surgical) is justified.