The role of oral steroids in the treatment of otitis media with effusion in children is the subject of ongoing debate. To critically evaluate the existing evidence, we performed a formal meta-analysis of six randomized clinical trials (n = 264 children) selected from 14 articles and abstracts. Children receiving steroids for 7 to 14 days were 3.6 times more likely than placebo-treated control subjects to have both ears free of effusion at the end of therapy (95% confidence interval, 2.2 to 4.1). This finding was essentially unchanged when the studies were weighted by a quality score, or stratified by use of concurrent antibiotic. The presence of significant heterogeneity among these studies suggests that additional trials will be needed to identify the specific subset(s) of children most likely to benefit from steroid therapy.