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Media support is not essential for a sip pbx, although it can make the cloud use case much simpler if you want to avoid stun and turn by using symmetric rtp at the pbx, which means your media reply goes to where the media source appears to actually come from rather than relying on the sdp to be correct. UDP, especially for sip, can also be easier in the cloud if baking in this kind of assumption and using keep-alives to keep router udp pinholes open without requiring explicit firewall forwarding rules. Few do it this way, but it does make a lot of the nasty problems and complexities with nat, firewalls, etc, go away.
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Media support is not essential for a sip pbx, although it can make the cloud use case much simpler if you want to avoid stun and turn by using symmetric rtp at the pbx, which means your media reply goes to where the media source appears to actually come from rather than relying on the sdp to be correct. UDP, especially for sip, can also be easier in the cloud if baking in this kind of assumption and using keep-alives to keep router udp pinholes open without requiring explicit firewall forwarding rules. Few do it this way, but it does make a lot of the nasty problems and complexities with nat, firewalls, etc, go away.