| 課程大綱 | Acute otitis media (AOM) is one of the most common childhood infection diseases. AOM is characterized by the presence of middle ear effusion with an acute onset of signs and symptoms caused by middle ear inflammation. Preceding viral upper respiratory infection or hypertrophied adenoids leads to eustachian tube dysfunction. Air trapped in the middle ear is resorbed, causing negative pressure in this cavity and facilitating reflux of nasopharyngeal bacteria. The most common pathogens in AOM include Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis. After the introduction of pneumococcal conjugate vaccines, AOM caused by pneumococcus declined significantly. Treatment of AOM includes administration of antipyretic, analgesics, and antibiotics. In Taiwan, antibiotics are prescribed for most of AOM episodes among children. However, the clinical symptoms of mild AOM resolve spontaneously without antibiotics in most of children within three days. Antibiotics increase the risks of adverse effects such as vomiting, diarrhea and rash. Watchful waiting is an alternative strategy for mild AOM in children aged 2 years or more. Longer courses (10-day) of antibiotics reduce short-term treatment failure than 5-day courses. The complications of AOM include tympanic membrane perforation, chronic effusion, hearing loss, cholesteatoma, petrositis, mastoiditis, and subdural empyema. Otitis media with effusion is the most common sequela of AOM. Persistent middle ear effusion may evaluated for indications for grommet tube insertion. The prevention of AOM include breastfeeding, cessation of bottle-feeding and pacifier use, smoke-free environment, vaccination with pneumococcal conjugate vaccine and influenza. |
兒童及嬰兒急性中耳炎