Bluestone C D
University of Pittsburgh School of Medicine and the Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, PA 15213, USA.
Pediatr Infect Dis J. 1998 Nov;17(11):1090-8; discussion 1099-100. doi: 10.1097/00006454-199811000-00040.
Otitis media is currently the most common diagnosis made by clinicians, and its prevalence has an impact on managed health care. With the emergence of bacterial pathogens resistant to many antimicrobial agents, an urgent need exists to reassess the indications for surgical management of this more prevalent disease. In an effort to determine the causative bacterial etiology of acute otitis media, which may be resistant to commonly prescribed antimicrobial agents, tympanocentesis is indicated today more than ever, especially when patients fail to improve or worsen while receiving antibiotics (i.e. treatment failures). In an effort to reduce the use of antimicrobial agents, prophylactic administration of these drugs for prevention of recurrent otitis media should only be prescribed on an individualized basis, with myringotomy and tympanostomy tube insertion being a more reasonable alternative. Adenoidectomy should be also considered when moderate to severe nasal obstruction is present or when repeat tympanostomy tube placement is needed. Likewise when chronic otitis media with effusion is unresponsive to a trial of antimicrobial therapy, tympanostomy tube insertion, adenoidectomy or both procedures should be considered, as opposed to re-treating with a variety of antibiotics. The role of these surgical procedures has become more important today in this era of antibiotic-resistant bacteria. Also in our cost-conscious environment, it is uncertain which method of management is more expensive, surgery or prolonged medical management.
中耳炎是目前临床医生最常做出的诊断，其患病率对管理式医疗保健有影响。随着对多种抗菌药物耐药的细菌病原体的出现，迫切需要重新评估这种更常见疾病的手术治疗指征。为了确定可能对常用抗菌药物耐药的急性中耳炎的致病细菌病因，如今鼓膜穿刺术比以往任何时候都更有必要，尤其是当患者在接受抗生素治疗时病情未改善或恶化（即治疗失败）的情况下。为了减少抗菌药物的使用，预防性使用这些药物预防复发性中耳炎应仅在个体化基础上进行，鼓膜切开术和鼓膜置管术是更合理的替代方法。当中度至重度鼻塞存在或需要重复鼓膜置管时，也应考虑腺样体切除术。同样，当慢性分泌性中耳炎对抗菌治疗试验无反应时，应考虑鼓膜置管术、腺样体切除术或两种手术，而不是用多种抗生素重新治疗。在这个细菌耐药的时代，这些外科手术的作用如今变得更加重要。而且在我们注重成本的环境中，不确定哪种管理方法更昂贵，是手术还是长期药物治疗。
