Otitis media with effusion (OME) is the long-term deposition of mucus in the middle ear cleft. It is the leading cause of childhood hearing loss and a common childhood infection. It can impair communication and life quality. OME's direct and indirect costs are also crucial. Improving OME care is crucial. This study examines intranasal mometasone's efficacy in treating otitis media with effusion. A clinical trial study was conducted during a period from January 2021 to June 2022. It included 80 patients suffering from otitis media with effusion bilaterally (160 ears) who had an intact tympanic membrane and tympanometry type B. These patients were included only if they had a hearing change or loss noted by the parents or by the patient if he or she could complain for three months or more. These patients were split into two groups. Group A had 80 ears (40 patients) who got one puff of mometasone furoate nasal spray in each nostril every day for three months, and Group B had 80 ears (40 patients) who got one puff of seawater nasal spray in each nostril every day for the same period. On the first visit, otoscopic findings were recorded, and all patients had pure-tone audiometry and tympanometry performed. All of the above-mentioned measures were repeated and compared to the records from the first visit at the end of the three months of treatment. After treatment, 75% of ears in Group A changed from type B to type A tympanometry. This was significantly higher than in Group B, where only 15% of ears changed from type B to type A tympanometry. Regarding retraction, 75% of ears in Group A showed no retraction after treatment with mometasone furoate, while in Group B, it was 40%. The average pure-tone audiometry score in Group A improved after therapy. Corticosteroids are effective in the treatment of otitis media with effusion and safer when used as topical intranasal steroids than systemic preparations.