Eythorsson E, et al. - In children under five years of age in Iceland, researchers evaluated the effect of the 10-valent pneumococcal vaccine (PHiD-CV) on tympanostomy tube placements (TTP), the most common paediatric surgical procedure in high-income countries. This investigation followed 11 consecutive birth cohorts from birth to the 5th birthday from 2005 to 2015. Data reported that the estimated vaccine impact on TTP was −6%. Investigators found that children in vaccine-eligible cohorts had fewer previous diagnoses of otitis media and fewer antimicrobials were prescribed before the procedure vs children in non-eligible cohorts. The results obtained from this population-based observational cohort indicate that tympanostomy procedures increased in Iceland during the study period in spite of high uptake of PHiD-CV10. Prior to the procedure, vaccine-eligible children had milder disease. The reason for this finding is speculative.