Abstract：Objective To explore the effects of Erlong Zuoci Pill combined with betamethasone on the hearing level and inflammatory factor levels in patients with secretory otitis media （SOM）.  Methods A total of 94 SOM patients admitted to Tianmen Traditional Chinese Medicine Hospital Affiliated to Hubei University of Traditional Chinese Medicine from July 2023 to January 2025 were selected and randomly divided into the experimental group and the conventional group with 47 cases each by random number table method. The conventional group was treated with betamethasone, while the experimental group was treated with Erlong Zuoci Pill on the basis of the conventional group. The curative effect, symptom scores, hearing level, inflammatory factor levels, immune function and adverse reactions were compared between the two groups. Results After treatment, the total effective rate of the experimental group was higher than that of the conventional group, and the difference between the groups was statistically significant （χ2＝4.374, P＜0.05）. After treatment, the scores of ear closure, hearing loss and tinnitus in both groups decreased; the air-conduction hearing thresholds at 0.5, 1, and 2 kHz decreased; the levels of IL-8, PCT, and TNF-α decreased, and those in the experimental group were lower, with statistically significant differences between the groups （t＝7.235, 9.021, 8.791, 3.546, 3.814, 3.060, 13.806, 11.923, 14.014; all P＜0.05）. The levels of CD3＋and CD4＋increased, and CD8＋decreased in both groups, and the experimental group showed better results, with statistically significant differences in the above indicators between the groups （t＝6.895, 3.543, 6.851; all P＜0.001）. However, there was no significant difference in the incidence of adverse reactions between the two groups （χ2＝0.448, P＞0.05）.  Conclusion The combination therapy of Erlong Zuoci Pill and betamethasone is safe and effective in SOM. It can reduce inflammatory indicators， enhance immunity, improve hearing level, and accelerate the relief of symptom.