McCormick David P, Saeed Kokab A, Pittman Carmen, Baldwin Constance D, Friedman Norman, Teichgraeber Davis C, Chonmaitree Tasnee
Division of General Academic Pediatrics, University of Texas Medical Branch at Galveston, Galveston, TX 77555-1119, USA.
Pediatrics. 2003 Oct;112(4):982-6. doi: 10.1542/peds.112.4.982.
Prior studies have shown that bullous myringitis (BM) accounts for <10% of acute otitis media (AOM) cases, and that the distribution of viral and bacterial pathogens in BM is similar to that in AOM without BM, except for a relative increase in the proportion of Streptococcus pneumoniae in BM. We studied 518 cases of AOM in children aged 6 months to 12 years. Using tele-otoscopy to assist the diagnosis, we identified 41 cases (7.9%) with BM. Children who had AOM with BM were older than AOM patients without BM (median age: 4.3 years vs 18 months). We compared 41 cases of AOM with BM to 41 control cases of age-, race-, and gender-matched AOM patients without BM. When compared with this matched control group, children with BM had more severe symptoms at the time of diagnosis and were more likely to have bulging of the tympanic membrane in the quadrants that were not obscured by the bulla. Children with AOM and BM may require aggressive pain management. Although parents and clinicians may agree that a watchful waiting approach is appropriate for older children with mild AOM, children experiencing painful AOM with BM may not be successful candidates for a watchful-waiting approach, because parents may resist postponement of antibiotic therapy in children who are more symptomatic.
先前的研究表明，大疱性鼓膜炎（BM）在急性中耳炎（AOM）病例中占比不到10%，并且BM中病毒和细菌病原体的分布与无BM的AOM相似，只是BM中肺炎链球菌的比例相对增加。我们研究了518例年龄在6个月至12岁的儿童AOM病例。通过使用远程耳镜辅助诊断，我们识别出41例（7.9%）患有BM的病例。患有AOM合并BM的儿童比无BM的AOM患者年龄更大（中位年龄：4.3岁对18个月）。我们将41例AOM合并BM的病例与41例年龄、种族和性别匹配的无BM的AOM对照病例进行了比较。与这个匹配的对照组相比，患有BM的儿童在诊断时症状更严重，并且在未被大疱遮挡的象限中鼓膜膨出的可能性更大。患有AOM和BM的儿童可能需要积极的疼痛管理。尽管家长和临床医生可能一致认为，密切观察等待方法适用于症状较轻的大龄AOM儿童，但经历疼痛性AOM合并BM的儿童可能不是密切观察等待方法的合适人选，因为家长可能会抵制对症状更明显的儿童推迟抗生素治疗。
