 Tympanometry is a well established technique for documentation of middle ear effusion. Tympanometry measures the compliance of the tympanic membrane over a range of pressures. A graphic curve is generated which can be compared to normals or examples of pathologic conditions. Primary care physicians have used this technique successfully among children with and without a diagnosis of AOM.15 Two studies involving tympanometry and otitis media16-17 have shown tympanograms consistent with clear middle ear effusionType B in 50-60 of patients clinically diagnosed with AOM. This strongly suggests that AOM is being over diagnosed! Interestingly Spiro et al showed that rates of antibiotic prescription were not different in physicians who were aware of tympanogram results and those who were blinded. This indicates a lack of knowledge around the impact on outcome of the initial tympanogram. 