Nokso-Koivisto Johanna, Marom Tal, Chonmaitree Tasnee
aDepartment of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland bDepartment of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, Holon, Israel cDivision of Infectious Diseases, Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA.
Curr Opin Pediatr. 2015 Feb;27(1):110-5. doi: 10.1097/MOP.0000000000000184.
Acute otitis media occurs as a complication of viral upper respiratory tract infection. Bacterial otopathogens and respiratory viruses interact and play important roles in acute otitis media development. A better understanding of viral and bacterial interactions may lead to innovative ways to lessen the burden of this common childhood disease.
There has been increasing evidence that acute otitis media occurs during upper respiratory infection, even in the absence of nasopharyngeal bacterial colonization. Among the types of viruses associated with acute otitis media, respiratory syncytial virus continues to be the most commonly detected. It is still unclear whether viral load plays an important role in acute otitis media development, but symptomatic upper respiratory tract infection (as opposed to asymptomatic viral infection) is crucial. Widespread use of bacterial and viral vaccines in young children, including pneumococcal conjugate and influenza vaccines, has led to the reduction in otitis media-related healthcare use between 2001 and 2011. There has been no new vaccine against respiratory viruses other than influenza.
Progress has been made toward the reduction of the burden of acute otitis media in the last decade. Success in reducing acute otitis media incidence will rely mainly on prevention of nasopharyngeal otopathogen colonization, as well as reduction in the incidence of viral upper respiratory tract infection.
急性中耳炎是病毒性上呼吸道感染的并发症。耳部细菌病原体与呼吸道病毒相互作用，在急性中耳炎的发生发展中起重要作用。更好地理解病毒与细菌的相互作用可能会带来减轻这种常见儿童疾病负担的创新方法。
越来越多的证据表明，即使在没有鼻咽部细菌定植的情况下，上呼吸道感染期间也会发生急性中耳炎。在与急性中耳炎相关的病毒类型中，呼吸道合胞病毒仍然是最常检测到的。病毒载量是否在急性中耳炎的发生发展中起重要作用尚不清楚，但有症状的上呼吸道感染（与无症状病毒感染相对）至关重要。2001年至2011年间，在幼儿中广泛使用细菌和病毒疫苗，包括肺炎球菌结合疫苗和流感疫苗，导致与中耳炎相关的医疗保健使用减少。除流感外，尚无针对呼吸道病毒的新疫苗。
在过去十年中，减轻急性中耳炎负担方面已取得进展。降低急性中耳炎发病率的成功将主要依赖于预防鼻咽部耳部病原体定植，以及降低病毒性上呼吸道感染的发病率。
