Shapiro A M, Bluestone C D
Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, PA 15213, USA.
Postgrad Med. 1995 May;97(5):73-6, 79-82.
For children with acute otitis media, appropriate antibiotic therapy provides a modest improvement over the high rate of spontaneous recovery and, more importantly, has greatly reduced the incidence of serious complications. Prophylaxis with antibiotics is beneficial for patients with recurrent episodes. Otitis media with effusion also has a high rate of spontaneous resolution, and many physicians have adopted a "wait and see" approach to this problem. Modification of risk factors may be helpful. Antibiotic therapy is recommended for infants who have otitis media with effusion (since they cannot relate symptoms); patients with a coexisting purulent infection of the upper respiratory tract; patients who have significant hearing loss, vertigo, or structural changes in the tympanic membrane; and patients who have had effusion for more than 2 to 3 months. Referral to an otolaryngologist should be considered if medical therapy for recurrent acute otitis media or chronic otitis media with effusion has failed or been poorly tolerated, or if complications are present.
对于急性中耳炎患儿，适当的抗生素治疗相比于较高的自然恢复率仅有适度改善，更重要的是，已大幅降低了严重并发症的发生率。抗生素预防对复发性发作的患者有益。中耳积液也有较高的自然消退率，许多医生对这个问题采取了“观察等待”的方法。改变危险因素可能会有帮助。对于患有中耳积液的婴儿（因为他们无法诉说症状）、同时患有上呼吸道化脓性感染的患者、有明显听力损失、眩晕或鼓膜结构改变的患者以及积液持续超过2至3个月的患者，建议使用抗生素治疗。如果复发性急性中耳炎或慢性中耳积液的药物治疗失败或耐受性差，或者存在并发症，则应考虑转诊至耳鼻喉科医生处。
