OTITIS-MEDIA
OTITIS-MEDIA
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DOI：
10.1093/clinids/19.5.823
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发表时间：
1994-11-01
影响因子：
11.8
通讯作者：
KLEIN, JO
中科院分区：
文献类型：
--
作者：
KLEIN, JO
中耳炎是儿童到医生处就诊的最常见的疾病; 1990年，据报约有2 450万儿童到医生处就诊。到3岁时，大约四分之三的儿童将至少有一次急性中耳炎发作，超过三分之一的儿童将有复发性感染（定义为三次或三次以上发作）。急性中耳炎的定义是中耳内存在液体，并伴有急性疾病的体征。渗出性中耳炎是指中耳内有积液，但无急性感染的体征或症状。在每次急性感染发作后，无论用于治疗的抗生素类型如何，中耳积液持续数周至数月。中耳积液时听力受损。化脓性并发症现在在儿童可以获得医疗护理的地区并不常见，但是患有复发性中耳炎的婴幼儿可能会因为中耳炎伴随的听力损失而在言语和认知能力的发育方面受到长期影响。中耳炎的管理包括三个问题：急性中耳炎的管理（选择适当的抗菌剂）;急性中耳炎发作或渗出性中耳炎发作后发生的持续性中耳积液的管理（使用抗生素和/或类固醇或通气管）;和预防复发性和严重急性中耳炎儿童的新感染（化学预防和疫苗）。这篇最先进的临床文章的目的是为读者提供流行病学、发病机制、诊断、微生物学、临床过程和中耳炎（包括急性和慢性形式的疾病）管理的综述。
Otitis media is the most frequent condition for which children make office visits to physicians; in 1990, approximately 24.5 million such visits were reported. By 3 years of age, approximately three-quarters of children will have had at least one episode of acute otitis media, and more than one-third of children will have had recurrent infections (defined as three or more episodes). Acute otitis media is defined by the presence of fluid in the middle ear accompanied by a sign of acute illness. Otitis me-dia with effusion is defined by the presence of fluid in the middle ear without signs or symptoms of acute infection. After every episode of acute infection, irrespective of the type of antibiotic used for therapy, effusion persists in the middle ear for weeks to months. Hearing is impaired whenever an effusion fills the middle ear. Suppurative complications are now uncommon in areas where children have access to medical care, but infants and young children with recurrent middle ear infections may suffer long-term effects with respect to the development of speech and cognitive abili-ties because of the hearing loss that accompanies otitis me-dia.The management of otitis media encompasses three issues: management of acute otitis media (choice of an appropriate antimicrobial agent); management of the persistent middle ear effusion that occurs after an episode of acute otitis media or an episode of otitis media with effusion (use of antibiotics and/or steroids or ventilating tubes); and prevention of new infections in children with recurrent and severe acute otitis media (chemoprophylaxis and vaccines). The purpose of this state-of-the-art clinical article is to provide readers with a review of the epidemiology, pathogenesis, diagnosis, microbiology, clinical course, and management of otitis media (both the acute and chronic forms of the dis-