Department of Emergency Medicine, Oregon Health and Science University, CDW-EM, 3181 SouthWest Sam Jackson Park Road, Portland, OR 97239, USA.
Expert Rev Anti Infect Ther. 2011 Feb;9(2):177-81. doi: 10.1586/eri.10.175.
Acute otitis media (AOM) is the most common bacterial infection in childhood, accounting for more than 10 million prescriptions written in the USA alone. Otoscopy is the only method to diagnose AOM, is difficult to perform in young children and has been found to be inaccurate. Otoscopy has certain risks, the most common of which are child discomfort, trauma to the external ear canal and parental anxiety. Current guidelines emphasize the importance of making an accurate diagnosis of AOM, which includes the presence of fever, otalgia or both. We propose a new strategy to limit the use of otoscopy to circumstances in which the pretest probability of AOM is high. We suggest indications for mandatory otoscopy and a flow chart outlining a proposal for limiting otoscopy in the management of AOM. Clinical research evaluating the rational use of otoscopy is encouraged to evaluate outcomes and acceptance of this proposal. Limiting otoscopy to clinical conditions in which the likelihood of AOM is high may reduce unnecessary pain and anxiety associated with the procedure, reduce rates of misdiagnosis and support the more judicious use of antibiotics.
急性中耳炎（AOM）是儿童中最常见的细菌性感染，仅在美国就开具了超过 1000 万份处方。耳镜检查是诊断 AOM 的唯一方法，但在幼儿中难以进行，且被发现不够准确。耳镜检查存在一定风险，最常见的是儿童不适、外耳道创伤和父母焦虑。目前的指南强调了准确诊断 AOM 的重要性，其中包括发热、耳痛或两者兼有。我们提出了一种新策略，将耳镜检查的使用限制在 AOM 的术前可能性高的情况下。我们建议了强制性耳镜检查的指征，并提出了一个流程图，概述了在 AOM 管理中限制耳镜检查的建议。鼓励开展评估耳镜合理使用的临床研究，以评估该方案的效果和接受程度。将耳镜检查限于 AOM 可能性高的临床情况，可能会减少与该程序相关的不必要的疼痛和焦虑，降低误诊率，并支持更明智地使用抗生素。
