Heidemann C H, Lous J, Berg J, Christensen J J, Håkonsen S J, Jakobsen M, Johansen C J, Nielsen L H, Hansen M P, Poulsen A, Schousboe L P, Skrubbeltrang C, Vind A B, Homøe P
Danish Health and Medicines Authority, Denmark; Department of ENT - Head & Neck Surgery, Odense University Hospital, Denmark; Department of Otorhinolaryngology, Vejle Hospital, Denmark.
Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Denmark.
Int J Pediatr Otorhinolaryngol. 2016 Aug;87:154-63. doi: 10.1016/j.ijporl.2016.06.003. Epub 2016 Jun 7.
Otitis media is one of the most common diseases in small children. This underlines the importance of optimizing diagnostics and treatment of the condition. Recent literature points toward a stricter approach to diagnosing acute otitis media (AOM). Moreover, ventilating tube treatment for recurrent AOM (RAOM) and chronic otitis media with effusion (COME) has become the most frequently performed surgical procedure in pre-school children. Therefore, the Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology, Head and Neck Surgery deemed it necessary to update the Danish guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of RAOM and COME.
The GRADE system (The Grading of Recommendations Assessment, Development and Evaluation) was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted between July and December 2014. The quality of the existing literature was assessed using AGREE II (Appraisal of Guidelines for Research & Evaluation), AMSTAR (assessing the Methodological Quality of Systematic Reviews), QUADAS-2 (Quality of Diagnostic Accuracy Studies), Cochrane Risk of Bias Tool for randomized trials and ACROBAT-NRSI (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies). The working group consisted of otolaryngologists, general practitioners, pediatricians, microbiologists and epidemiologists.
Recommendations for AOM diagnosis, surgical management for RAOM and COME, including the role of adenoidectomy and treatment of ventilating tube otorrhea, are proposed in the guideline.
中耳炎是幼儿最常见的疾病之一。这凸显了优化该病症诊断和治疗的重要性。近期文献表明对急性中耳炎（AOM）的诊断应采取更严格的方法。此外，对于复发性急性中耳炎（RAOM）和慢性分泌性中耳炎（COME）的通气管治疗已成为学龄前儿童最常进行的外科手术。因此，丹麦卫生和药品管理局以及丹麦耳鼻咽喉头颈外科学会认为有必要更新丹麦关于急性中耳炎诊断标准以及RAOM和COME外科治疗的指南。
为了在制定建议时符合当前证据评估标准，使用了GRADE系统（推荐评估、制定与评价分级系统）。2014年7月至12月进行了广泛的文献检索。使用AGREE II（研究与评价指南评估）、AMSTAR（评估系统评价的方法学质量）、QUADAS - 2（诊断准确性研究的质量）、随机试验的Cochrane偏倚风险工具以及ACROBAT - NRSI（非随机研究的Cochrane偏倚风险评估工具）对现有文献的质量进行评估。工作组由耳鼻咽喉科医生、全科医生、儿科医生、微生物学家和流行病学家组成。
该指南提出了关于AOM诊断、RAOM和COME外科治疗的建议，包括腺样体切除术的作用以及通气管耳漏的治疗。
