We thank Drs Hoberman and Paradise for writing to highlight areas of disagreement and for pointing out a couple of minor errors in our commentary.

Our commentary was a comparison between the paper by Hoberman, Paradise et al, and one by Tahtinen et al in the same issue of the New England Journal of Medicine. Because of space limitations, we focused only on the primary outcomes of both studies. The primary outcome of the study by Hoberman et al was symptomatic response.

In their letter, Hoberman and Paradise suggest that overall clinical response, which in their study differed more between groups but was largely based on otoscopic findings, is more important. We disagree. In assessing the magnitude of benefit of antibiotics for acute otitis media (AOM) in studies such as this one, we feel that clinicians should consider symptomatic response as the most important outcome, for three reasons: (1) shortened symptom duration is a desirable …