Kenna Margaret A
Department of Otolaryngology and Communication Disorders, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
J Otolaryngol. 2005 Jun;34 Suppl 1:S24-32.
Otitis media, including recurrent acute otitis media (AOM) and otitis media with effusion (OME), is one of the most common reasons for an illness-related visit to the primary care clinician. Until recently, antibacterial therapy was the standard treatment for most episodes of AOM and often for OME. However, in 1994, a clinical practice guideline on OME was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality) and applied to normal children aged 1 to 3 years. The recommendations in the 1994 guideline were evidence based, widely discussed, and somewhat controversial but also acted as a starting point for some ideas about standardization of management of this very common disease. In 2004, revised clinical practice guidelines were published for OME that applied to children aged 2 months to 12 years and included children with developmental disabilities and underlying conditions that predispose them to OME. In addition, a new evidence-based clinical practice guideline for AOM was published in 2004. This guideline recognized that many episodes of AOM will resolve on their own without antimicrobial therapy, and on that basis, one of the recommendations for initial treatment of AOM in specified situations was watchful waiting without antibacterial therapy. This article briefly discusses the current knowledge about AOM and OME and then addresses the new AOM and OME guidelines point by point. It is important to remember that although important, these clinical practice guidelines are just guidelines and that actual management of the patient with otitis media depends on clinical judgement, the severity of the illness, other underlying medical conditions, ready access to adequate follow-up care, and other features, such as cultural differences. Surgical recommendations were not included in the AOM guidelines but were addressed in the OME guidelines. Further information about the efficacy and effectiveness of both sets of guidelines will likely include the results of prospective studies using the guidelines in both normal children and those with underlying medical conditions.
中耳炎，包括复发性急性中耳炎（AOM）和分泌性中耳炎（OME），是患者因疾病就诊于初级保健医生的最常见原因之一。直到最近，抗菌治疗仍是大多数AOM发作以及通常OME发作的标准治疗方法。然而，1994年，医疗保健政策与研究机构（现为医疗保健研究与质量机构）制定了关于OME的临床实践指南，并应用于1至3岁的正常儿童。1994年指南中的建议基于证据，经过广泛讨论，虽有些争议，但也为这种非常常见疾病的管理标准化理念提供了一个起点。2004年，针对OME发布了修订后的临床实践指南，适用于2个月至12岁的儿童，包括有发育障碍和易患OME潜在疾病的儿童。此外，2004年还发布了一项新的基于证据的AOM临床实践指南。该指南认识到许多AOM发作无需抗菌治疗即可自行缓解，在此基础上，针对特定情况下AOM初始治疗的一项建议是观察等待，不进行抗菌治疗。本文简要讨论了关于AOM和OME的当前知识，然后逐点阐述新的AOM和OME指南。重要的是要记住，尽管这些临床实践指南很重要，但它们只是指南，中耳炎患者的实际管理取决于临床判断、疾病严重程度、其他潜在医疗状况、能否随时获得充分的后续护理以及其他因素，如文化差异。AOM指南未包括手术建议，但OME指南中有涉及。关于这两套指南的疗效和有效性的更多信息可能包括在正常儿童和有潜在医疗状况的儿童中使用这些指南的前瞻性研究结果。
