Eythorsson E, et al. - In children under five years of age in Iceland, researchers evaluated the impact of the 10-valent pneumococcal vaccine (PHiD-CV) on tympanostomy tube placements (TTP). This population-based observational cohort study followed eleven consecutive birth-cohorts from birth to the fifth birthday in 2005- 2015. It was noted that the estimated vaccine impact on TTP was -6%. Compared to children in the vaccine non-eligible cohorts, children in the vaccine eligible cohorts had fewer previous otitis media diagnoses and had been prescribed fewer antimicrobials prior to the procedure. They observed that tympanostomy procedures increased in Iceland during the study period despite high uptake of PHiD-CV10. Before the procedure, vaccine eligible children had milder disease. The reason behind these conclusions is speculative.