Akut Otitis Media
Özet
Akut otitis media,orta kulak sıvısının akut enfeksiyonudur. Ani başlayan kulak ağrısı, ateş ve otore önemli şikayetlerdir. Otoskopik muayenede kulak zarının bombe ve hiperemik olması, kulak zarının hareketsiz olması ve otorenin görülmesi tanı koydurucudur. AOM tanısı koyulmuş olan 6 aydan küçük hastalar, otoresi olan hastalar, otalji ve 39°C’den yüksek ateşin 48 saatten uzun sürdüğü hastalar, toksik görünen hastalar, 2 yaş ve altındaki çocuklarda iki taraflı akut otitis media varlığında, immün yetmezliği olan veya kraniyofasiyal anatomik anormallikleri olan hastalara antibiyotik tedavisi verilmelidir. Şiddetli belirti veya semptomları olmayan 6 ay ile 23 ay arasındaki çocuklarda tek taraflı daha büyük çocuklarda tek ya da iki taraflı AOM varlığında antibiyotik reçete edilmeden gözlem yapılabilir. İzlemde hasta semptomlarının ve otoskopik muayenenin kötüleşmesi durumunda antibiyotik tedavisi başlanmalıdır. Çocuklarda AOM tedavisinde ilk tercih amoksisilin veya amoksisilin klavulonattır. Alternatif tedaviler, sefdinir, sefpodoksim, sefuroksim ya da seftriakson tedavileridir. AOM’si olan yenidoğanların sepsis açısından mutlaka değerlendirilmesi gerekir.
Referanslar
Brittany Player, Nelson Textbook of Pediatrics, Chapter 680, 4003-4016.e2
Rosenfeld RM, Tunkel DE, Schwartz SR et al. Executive Summary of Clinical Practice Guideline on Tympanostomy Tubes in Children (Update). Otolaryngol Head Neck Surg. 2022 Feb;166(2):189-206. doi: 10.1177/01945998211065661. PMID: 35138976.
Verhoeff M, van der Veen EL, Rovers MM, Sanders EA, Schilder AG. Chronic suppurative otitis media: a review. Int J Pediatr Otorhinolaryngol. 2006 Jan;70(1):1-12. doi: 10.1016/j.ijporl.2005.08.021. Epub 2005 Sep 27. PMID: 16198004.
Tong S, Amand C, Kieffer A, Kyaw MH. Trends in healthcare utilization and costs associated with pneumonia in the United States during 2008-2014. BMC Health Serv Res. 2018 Sep 14;18(1):715. doi: 10.1186/s12913-018-3529-4. PMID: 30217156; PMCID: PMC6137867.
Kaur R, Morris M, Pichichero ME. Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era. Pediatrics. 2017 Sep;140(3):e20170181. doi: 10.1542/peds.2017-0181. Epub 2017 Aug 7. Erratum in: Pediatrics. 2018 Mar;141(3):e20174067. doi: 10.1542/peds.2017-4067. PMID: 28784702; PMCID: PMC5574724.
Lieberthal AS, Carroll AE, Chonmaitree T et al: The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-99. doi: 10.1542/peds.2012-3488. Epub 2013 Feb 25. Erratum in: Pediatrics. 2014 Feb;133(2):346. Dosage error in article text. PMID: 23439909.
Coker TR, Chan LS, Newberry SJ et al: Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010 Nov 17;304(19):2161-9. doi: 10.1001/jama.2010.1651. PMID: 21081729
Vishwanath S, Mukhopadhyay C, Prakash R et al: Chronic suppurative otitis media: optimizing initial antibiotic therapy in a tertiary care setup. Indian J Otolaryngol Head Neck Surg. 2012 Sep;64(3):285-9. doi: 10.1007/s12070-011-0287-6. Epub 2011 Sep 13. PMID: 23998037; PMCID: PMC3431529.
Mongkolrattanothai K, Oram R, Redleaf M, Bova J, Englund JA. Tuberculous otitis media with mastoiditis and central nervous system involvement. Pediatr Infect Dis J. 2003 May;22(5):453-6. doi: 10.1097/01.inf.0000066245.88741.bf. PMID: 12792390.
Sarasoja I, Jokinen J, Lahdenkari M, Kilpi T, Palmu AA. Long-term effect of pneumococcal conjugate vaccines on tympanostomy tube placements. Pediatr Infect Dis J. 2013 May;32(5):517-20. doi: 10.1097/INF.0b013e31827c9bcc. PMID: 23190780.
Dagan R, Pelton S, Bakaletz L, Cohen R. Prevention of early episodes of otitis media by pneumococcal vaccines might reduce progression to complex disease. Lancet Infect Dis. 2016 Apr;16(4):480-92. doi: 10.1016/S1473-3099(15)00549-6. PMID: 27036355
Ruohola A, Meurman O, Nikkari S et al: Microbiology of acute otitis media in children with tympanostomy tubes: prevalences of bacteria and viruses. Clin Infect Dis. 2006 Dec 1;43(11):1417-22. doi: 10.1086/509332. Epub 2006 Oct 31. PMID: 17083014; PMCID: PMC7107988.
Kotikoski MJ, Palmu AA, Nokso-Koivisto J, Kleemola M. Evaluation of the role of respiratory viruses in acute myringitis in children less than two years of age. Pediatr Infect Dis J. 2002 Jul;21(7):636-41. doi: 10.1097/00006454-200207000-00007. PMID: 12237595.
Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C. Topical analgesia for acute otitis media. Cochrane Database Syst Rev. 2006 Jul 19;2006(3):CD005657. doi: 10.1002/14651858.CD005657.pub2. PMID: 16856108; PMCID: PMC9006341.
Hayashi T, Kitamura K, Hashimoto S et al: Clinical practice guidelines for the diagnosis and management of acute otitis media in children-2018 update. Auris Nasus Larynx. 2020 Aug;47(4):493-526. doi: 10.1016/j.anl.2020.05.019. Epub 2020 Jun 20. PMID: 32576390.
Heidemann CH, Lous J, Berg J et al: Danish guidelines on management of otitis media in preschool children. Int J Pediatr Otorhinolaryngol. 2016 Aug;87:154-63. doi: 10.1016/j.ijporl.2016.06.003. Epub 2016 Jun 7. PMID: 27368465.
Turner D, Leibovitz E, Aran A et al: Acute otitis media in infants younger than two months of age: microbiology, clinical presentation and therapeutic approach. Pediatr Infect Dis J. 2002 Jul;21(7):669-74. doi: 10.1097/00006454-200207000-00013. PMID: 12237601.
Ingram DG, Friedman NR. Toward Adenotonsillectomy in Children: A Review for the General Pediatrician. JAMA Pediatr. 2015 Dec;169(12):1155-61. doi: 10.1001/jamapediatrics.2015.2016. PMID: 26436644.
Norhayati MN, Ho JJ, Azman MY. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database Syst Rev. 2017 Oct 17;10(10):CD010089. doi: 10.1002/14651858.CD010089.pub3. PMID: 29039160; PMCID: PMC6485791.
