van Buchem F L, Peeters M F, van 't Hof M A
Br Med J (Clin Res Ed). 1985 Apr 6;290(6474):1033-7. doi: 10.1136/bmj.290.6474.1033.
The incidence of acute otitis media and its response to treatment only with nose drops and analgesics (but without antibiotics or myringotomy) were assessed over three months by 45 doctors in and around Tilburg. In addition, over 17 months 60 general practitioners assessed the effects of this limited treatment in children aged 2 to 12 years and referred all those in whom the condition took an unsatisfactory course (either a severe course--illness continuing beyond three to four days with high temperature or pain, or both--or persistent discharge after 14 days) to an ear, nose, and throat specialist. Those referred because of appreciable illness continuing beyond three or four days were entered into a further study, comparing the effects of myringotomy alone, antibiotics alone, and myringotomy and antibiotics combined. Bacteriology was assessed in all children in whom the course of the condition was unsatisfactory. More than 90% of an estimated 4860 children seen over 17 months (estimation based on incidence of severe course in the three month study) recovered within a few days. The course of the condition was severe in only 126 (2.7%) patients; haemolytic streptococci group A were identified in 30 of these 126 patients but Haemophilus influenzae in only one. One hundred of these patients with a severe course entered the trial of treatment, which showed antimicrobial treatment either alone or in combination to be more effective than myringotomy alone. Whether combined treatment was more effective than antibiotics alone remained unconfirmed. Acute otitis media in children can be treated with nose drops and analgesics alone for the first three to four days. Patients in whom this regimen is not accompanied by satisfactory recovery can be recognised within a short time and treated by the general practitioner.
蒂尔堡及其周边地区的45名医生在三个月的时间里评估了急性中耳炎的发病率以及仅使用滴鼻剂和镇痛药（但不使用抗生素或鼓膜切开术）治疗的效果。此外，在17个月的时间里，60名全科医生评估了这种有限治疗方法对2至12岁儿童的效果，并将所有病情发展不理想的儿童（病情严重——疾病持续三到四天以上伴有高烧或疼痛，或两者皆有——或14天后持续流脓）转诊至耳鼻喉科专家处。因病情明显持续三到四天以上而被转诊的患者进入了进一步的研究，比较单独鼓膜切开术、单独使用抗生素以及鼓膜切开术和抗生素联合使用的效果。对所有病情发展不理想的儿童进行了细菌学评估。在17个月内就诊的约4860名儿童中（根据三个月研究中严重病情的发病率估算），超过90%的儿童在几天内康复。只有126名（2.7%）患者病情严重；在这126名患者中，有30名检测出A组溶血性链球菌，但只有1名检测出流感嗜血杆菌。其中100名病情严重的患者进入了治疗试验，结果显示单独使用抗菌治疗或联合使用抗菌治疗比单独鼓膜切开术更有效。联合治疗是否比单独使用抗生素更有效仍未得到证实。儿童急性中耳炎在最初的三到四天可以仅用滴鼻剂和镇痛药治疗。采用这种治疗方案但未取得满意康复效果的患者可以在短时间内被识别出来，并由全科医生进行治疗。
