 Currently at the Stollery, and as suggested by CPS and AMA well children who are diagnosed with AOM are given a prescription for antibiotics, but told to wait 48 hours before filling them, in the expectation that many of these children will have a complete resolution of their symptoms. They are encouraged to take analgesics to keep them comfortable. However, the current state of knowledge indicates that antibiotics provide superior symptom control in the first 24-48H and provide superior resolution rates to placebo in clinically diagnosed AOM. The delayed antibiotic strategy has similar long term outcomes to immediate antibiotic treatment. It is not clear if patients with middle ear effusion documented by adjunctive tests, such as tympanometry represent a distinctly different group than those diagnosed by observation of the tympanic membrane only. Spiros study indicates that physicians do not know and therefore are not changing their practice on the basis of tympanogram results. 