In a recent review published in International Journal of Otolaryngology, Fletcher and Fritzell provide a comprehensive and useful summary of the clinical trials assessing efficacy of pneumococcal conjugate vaccines (PCVs) against otitis media (OM) [1]. Although the Results section of the review is limited to clinical trial data, the Discussion section also includes interpretation of PCV “real-life impact” data derived from post-implementation database studies. We have some reservations about how these data are often interpreted that may affect Fletcher and Fritzell's overall conclusions. These points are stated more fully in our systematic review of PCV efficacy and effectiveness data published [2] around the same time as those authors' contribution.