 These results prompted interest in a watch and wait strategy for the treatment of AOM for children 6 months to 10 years of age. Three important studies were performed assessing the outcomes of delaying antibiotics for 48-72H, two in primary care9-10 and one in a pediatric emergency department.11 All three showed no difference in outcomes with 2-4 week follow-up. There was a significant reduction in antibiotic usage with the watch and wait approach, a reduction of about 70. These studies led both the American Academy of Pediatrics and the Canadian Pediatric Society to recommend adopting a conservative non-antibiotic treatment strategy for AOM in the first 48-72H.12 However in early 2011, 2 papers were published that suggested that antibiotic use in AOM was beneficial.13, 14 What set both of these two papers apart from other papers was the definition of acute otitis media: in one study the children were enrolled by study clinicians who were otoscopists who had successfully completed an otoscopic validation program, in the second study middle ear fluid had to be present by means of pneumatic otoscopy. The question then arises, is the treatment of otitis media really a question that concerns the treatment, or is it a question of diagnosis? The published correspondence that these two papers generated, suggested that diagnosis of AOM is indeed a concern. A technique named tympanometry could prove to be useful. 