Serous otitis media (SOM) is a common and troublesome disease in childhood. Although antihistamines are commonly prescribed to prevent or treat SOM, there have been no controlled clinical trials to determine the efficacy of such interventions. This study was designed to determine if antihistamines are of value in the prevention or treatment of SOM. Using a randomized double-blind method, 206 children with acute otitis media were treated with antibiotics and either brompheniramine maleate or placebo. The children were evaluated two weeks later by tympanometry and, independently, by combined pneumatoscopy and otoscopy. There were no significant differences overall between the treatment and control groups in terms of preventing SOM: 44% of those on antihistamine and 41% of those on placebo had SOM after two weeks of therapy. However, children with a history of serous otitis media did significantly better on placebo than did those on antihistamine, and children without a history of serous otitis media did significantly better on antihistamine than did those on placebo. One hundred children continued to use antihistamine or placebo for four more weeks. There were no significant differences between the treatment and control groups in terms of resolution of SOM (64% versus 68%).
A myringotomy (incision in the eardrum) is performed to remove the middle ear fluid. A hollow plastic tube or metal tube (ventilation tube) is inserted to prevent the incision from healing and to insure middle ear ventilation. The ventilation tube temporarily takes the place of the eustachian tube in equalizing middle ear pressure. This tube usually remains in place for six to nine months, during which time the eustachian tube blockage should subside. The tubes can be removed at a later date, but most of the time it is preferable to let the tubes work their way out of the eardrum. When the tube dislodges, the eardrum heals: the eustachian tube then resumes its normal pressure equalizing function. In rare instances (less than 5% of cases) the eardrum membrane does not heal following extrusion of the tube. The perforation may be repaired at a later date if this occurs. Usually this small perforation poses no problem, as it also would act as a ventilation tube.
The decision to treat is usually made after a combination of physical exam and laboratory diagnosis, with additional testing including audiometry , tympanogram , temporal bone CT and MRI .    Decongestants,  glucocorticoids,  and topical antibiotics are generally not effective as treatment for non-infectious, or serous , causes of mastoid effusion.  In less severe cases or those without significant hearing impairment, the effusion can resolve spontaneously or with more conservative measures such as autoinflation .  In more severe cases, tympanostomy tubes can be inserted, possibly with adjuvant adenoidectomy .