Marchant C D, Collison L M
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg.
Drugs. 1987 Dec;34(6):695-701. doi: 10.2165/00003495-198734060-00004.
The management of recurrent acute otitis media and serous otitis media is both challenging and controversial. The efficacy of antimicrobial prophylaxis of children at high risk for recurrent acute otitis media is established, but the indications for such therapy are controversial. Tympanostomy tube insertion also decreases the frequency of recurrent otitis media. High-risk children can be successfully managed with chemoprophylaxis from autumn through to spring. If this fails, then tympanostomy tube insertion should be considered. Serous otitis media that follows acute otitis media resolves spontaneously in more than 90% of cases. Serous otitis media of unknown onset also has a strong tendency to resolve without treatment. Antihistamines and decongestants, although popular, have no significant effect on the course of serous otitis media. Antimicrobial therapy has a modest effect on the resolution of serous otitis media. Tympanostomy tubes usually improve the conductive hearing loss associated with serous otitis media and should be used when bilateral serous otitis media fails to resolve spontaneously. If repeated tympanostomy tube insertion fails, then adenoidectomy should be considered. With the course of management outlined, most children will have a successful outcome with conservative therapy and the need for surgery will be minimised.
复发性急性中耳炎和浆液性中耳炎的治疗既具有挑战性又存在争议。对于复发性急性中耳炎高危儿童，抗菌药物预防的疗效已得到证实，但这种治疗的指征存在争议。鼓膜置管也可降低中耳炎复发的频率。高危儿童从秋季到春季通过化学预防可得到成功治疗。如果失败，则应考虑鼓膜置管。急性中耳炎后发生的浆液性中耳炎在90%以上的病例中可自发缓解。病因不明的浆液性中耳炎也有很强的未经治疗而自行缓解的倾向。抗组胺药和减充血剂虽然常用，但对浆液性中耳炎的病程没有显著影响。抗菌治疗对浆液性中耳炎的消退有一定作用。鼓膜置管通常可改善与浆液性中耳炎相关的传导性听力损失，双侧浆液性中耳炎不能自发缓解时应使用。如果反复鼓膜置管失败，则应考虑腺样体切除术。按照上述治疗过程，大多数儿童通过保守治疗可取得成功，手术需求将降至最低。
