Mandel E M, Casselbrant M L, Kurs-Lasky M
Otitis Media Research Center, Children's Hospital of Pittsburgh, PA 15213.
Ann Otol Rhinol Laryngol. 1994 Sep;103(9):713-8. doi: 10.1177/000348949410300909.
We prospectively followed 246 children with tympanostomy tubes and observed acute otorrhea through a functioning tube at least once in 50% of subjects. Pathogens typical of acute otitis media (Streptococcus pneumoniae, Hemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes) were found in 42% of all episodes; Pseudomonas aeruginosa or Staphylococcus aureus was found in 44% of all episodes. Pathogens of acute otitis media were found in 50.0% of subjects under 6 years old versus 4.4% of subjects 6 years or over at the first episode (p < .001). Pseudomonas aeruginosa was found more often in children 6 years or older (43.5% versus 20.5% at the first episode, p = .052). Pathogens typical of acute otitis media were less prevalent in the summer months (14.7% versus 52.2% for the first episode, p = .001), while P aeruginosa was more prevalent in summer (44.1% versus 16.4% for the first episode, p = .006). This suggests that while many younger children with acute otorrhea may respond to treatment with oral antimicrobials alone, outpatient therapy of older children may involve use of topical antipseudomonal agents that may be complicated by the question of the safety of such medications.
我们对246名行鼓膜置管术的儿童进行了前瞻性随访，观察到至少50%的受试者通过通畅的置管出现过一次急性耳漏。在所有发作中，42%发现了急性中耳炎的典型病原体（肺炎链球菌、流感嗜血杆菌、卡他莫拉菌和化脓性链球菌）；44%的发作中发现了铜绿假单胞菌或金黄色葡萄球菌。在首次发作时，6岁以下儿童中50.0%发现了急性中耳炎病原体，而6岁及以上儿童中这一比例为4.4%（p < 0.001）。6岁及以上儿童中铜绿假单胞菌的发现率更高（首次发作时为43.5%，而6岁以下儿童为20.5%，p = 0.052）。急性中耳炎的典型病原体在夏季的发生率较低（首次发作时为14.7%，而其他时间为52.2%，p = 0.001），而铜绿假单胞菌在夏季更为常见（首次发作时为44.1%，而其他时间为16.4%，p = 0.006）。这表明，虽然许多急性耳漏的年幼儿童可能仅通过口服抗菌药物治疗即可有效，但年龄较大儿童的门诊治疗可能需要使用局部抗铜绿假单胞菌药物，而这类药物的安全性问题可能会使治疗变得复杂。
