Çocukluk Çağı Akut Otitis Media: Tanı, Tedavi ve Güncel Yaklaşımlar
Özet
Akut otitis media (AOM), çocukluk çağında en sık görülen bakteriyel enfeksiyonlardan biri olup dünya genelinde antibiyotik reçetelerinin başlıca nedenleri arasında yer almaktadır. Bu bölümde çocukluk çağı AOM’nin güncel epidemiyolojisi, mikrobiyolojisi, tanısal zorlukları ve kanıta dayalı yönetim stratejileri kapsamlı biçimde ele alınmıştır. Pnömokok konjuge aşılarının yaygın kullanımı sonrası etiyolojik dağılımda belirgin değişimler meydana gelmiş; Streptococcus pneumoniae’ye bağlı olgular azalırken non-typeable Haemophilus influenzae’nin göreceli önemi artmıştır. Tanıda, ani semptom başlangıcı ile birlikte orta kulak efüzyonu ve timpan zarında inflamasyonun gösterilmesi esastır; ancak klinik uygulamada tanısal hatalar yaygın olup gereksiz antibiyotik kullanımına katkı sağlamaktadır. Yapay zekâ destekli otoskopi ve ileri görüntüleme yöntemleri, tanısal doğruluğu artırma potansiyeli taşımaktadır. Güncel kılavuzlar, komplike olmayan olgularda “bekle-gör” yaklaşımı ve etkin analjeziyi ön planda tutarken; yaş, semptom şiddeti ve risk faktörlerine göre seçilmiş hastalarda antibiyotik tedavisini önermektedir. Amoksisilin yüksek dozda ilk basamak tedavi olarak kabul edilmekte, tedavi süresinin kısaltılması antibiyotik direnciyle mücadelede önemli bir strateji olarak öne çıkmaktadır. AOM’de bağlı ciddi komplikasyonlar nadir olmakla birlikte erken tanı ve uygun sevk mortalite ve sekelleri azaltmaktadır. Korunmada emzirme, risk faktörlerinin azaltılması ve pnömokok ile influenza aşılaması temel yaklaşımlardır. Sonuç olarak, doğru tanı, akılcı antibiyotik kullanımı ve etkili korunma stratejilerinin birlikte uygulanması, AOM’nin bireysel ve toplumsal yükünü azaltmada temel rol oynamaktadır.
Acute otitis media is one of the most common bacterial infections in childhood and remains a leading cause of antibiotic prescriptions worldwide. This chapter provides a comprehensive overview of the current epidemiology, microbiology, diagnostic challenges, and evidence-based management of pediatric AOM. Following the widespread implementation of pneumococcal conjugate vaccines, the etiological landscape has shifted, with a decline in Streptococcus pneumoniae–related cases and an increasing relative importance of non-typeable Haemophilus influenzae. Diagnosis requires the presence of acute symptom onset, middle ear effusion, and signs of tympanic membrane inflammation; however, diagnostic inaccuracies remain common in clinical practice and contribute to unnecessary antibiotic use. Emerging technologies, including artificial intelligence-assisted otoscopy and advanced imaging, offer promising tools to improve diagnostic accuracy. Current guidelines emphasize effective analgesia and a watchful waiting strategy for uncomplicated cases, while recommending antibiotics for selected high-risk patients based on age, severity, and comorbidities. High-dose amoxicillin is considered first-line therapy, and shorter treatment durations play a key role in antimicrobial stewardship. Although serious complications are rare, early recognition and timely referral are essential to reduce morbidity and mortality. Preventive strategies include breastfeeding promotion, risk factor reduction, and pneumococcal and influenza vaccination. Overall, accurate diagnosis, rational antibiotic use, and preventive strategies are central to reducing the individual and societal burden of AOM.
Referanslar
Węgrzyn J, Fijałkowski Ł, Nosal A, et al. Acute Otitis Media in children – a review of current literature. Journal of Education, Health and Sport. 2025;79:57781.
Goldman RD. Acute otitis media in children 6 months to 2 years of age. Canadian Family Physician. 2022;68(8):589–590.
Parmanand K, Atfeh M. Acute otitis media. InnovAiT: Education and Inspiration for General Practice. 2023;16(8):381–386.
Wang H, Zeng X, Miao X, et al. Global, regional, and national epidemiology of otitis media in children from 1990 to 2021. Frontiers in Pediatrics. 2025;13. doi:10.3389/fped.2025.1513629
Sigurdsson S, Eythorsson E, Hrafnkelsson B, et al. Reduction in All-Cause Acute Otitis Media in Children <3 Years of Age in Primary Care Following Vaccination With 10-Valent Pneumococcal Haemophilus influenzae Protein-D Conjugate Vaccine. Clinical Infectious Diseases. 2018;67(8):1213–1219. doi:10.1093/cid/ciy233
Ricci Conesa H, Skröder H, Norton N, et al. Clinical and economic burden of acute otitis media caused by Streptococcus pneumoniae in European children. PLOS ONE. 2024;19(4):e0297098. doi:10.1371/journal.pone.0297098
Sirota SB, Doxey MC, Dominguez RMV, et al. Global burden of upper respiratory infections and otitis media, 1990–2021. The Lancet Infectious Diseases. 2025;25(1):36–51. doi:10.1016/S1473-3099(24)00430-4
Mariam S, Elmehdi EAMSAM, Lassana K, et al. Epidemiological Profiles of Acute Otitis Media. International Journal of Otorhinolaryngology. 2024;10(1):1–5.
Samaké L, Ahmadou D, Kalifa O, et al. Epidemiological, Clinical and Therapeutic Aspects of Acute Otitis Media. SAS Journal of Surgery. 2023;9(03):162–166.
Kaur R, Fuji N, Pichichero ME. Dynamic changes in otopathogens after PCV13 vaccination. European Journal of Clinical Microbiology & Infectious Diseases. 2022;41(1):37–44. doi:10.1007/s10096-021-04324-0
Tzovara I, Doudoulakakis A, Kalogeras G, et al. Bacterial Acute Otitis Media with Otorrhea. Pathogens. 2025;14(5):494.
Fuji N, Salamone FN, Kaur R, et al. Longitudinal Study of Acute Otitis Media During PCV Era. Journal of Infectious Diseases. 2025;232(2):417–429.
Kaur R, Schulz S, Sherman A, et al. Higher-valency PCV effects. Pediatric Infectious Disease Journal. 2024;43(10):1004–1010.
Dissanayake G, Zergaw M, Elgendy M, et al. Pneumococcal Vaccines and Resistant AOM. Cureus. 2024.
Setiawan EP, Rahayu ML, Saputra KAD, et al. Risk factors and management for AOM. GSC Advanced Research and Reviews. 2025;23(3):48–55.
Folino F, Caruso M, Bosi P, et al. AOM diagnosis in childhood. Italian Journal of Pediatrics. 2024;50(1):19.
Carson JJK, Urbach N, Leifso K. Otoscopy guideline adherence. Paediatrics & Child Health. 2025.
El Feghaly RE, Nedved A, Katz SE, et al. Treatment of AOM. Expert Review of Anti-Infective Therapy. 2023;21(5):523–534. doi:10.1080/14787210.2023.2206565
Surapaneni S, Rangarajan N, Davis K, et al. Deep learning classifier. Otolaryngology–Head and Neck Surgery. 2025;173(6):1485–1493.
Crowson MG, Hartnick CJ, Diercks GR, et al. Machine Learning Effusion Diagnosis. Pediatrics. 2021;147(4)
Shaikh N, Conway SJ, Kovačević J, et al. Automated classifier AOM. JAMA Pediatrics. 2024;178(4):401.
Esposito S, Bianchini S, Argentiero A, et al. Technologies to improve diagnosis. Diagnostics. 2021;11(12):2392.
Cai Y, Yu JG, Chen Y, et al. CNN diagnosis otitis media. BMJ Open. 2021;11(1):e041139.
Mousseau S, Lapointe A, Gravel J. Smartphone otoscope RCT. American Journal of Emergency Medicine. 2018;36(10):1796–1801.
Sundgaard JV, Harte J, Bray P, et al. Deep metric learning. Medical Image Analysis. 2021;71:102034.
El Feghaly RE, Nedved A, Katz SE, et al. Treatment of AOM. Expert Review of Anti-Infective Therapy. 2023;21(5):523–534. doi:10.1080/14787210.2023.2206565
McCormick DP, Grady JJ, Diego A, et al. AOM severity and risk factors. International Journal of Pediatric Otorhinolaryngology. 2011;75(5):708–712.
Venekamp RP, Sanders SL, Glasziou PP, et al. Antibiotics for AOM. Cochrane Database of Systematic Reviews. 2023(12).
Ali I, Akram A, Mangrio SAN, et al. Immediate vs delayed antibiotics. Pakistan Journal of Medical and Health Sciences. 2023;17(11):207–209
Takata GS, Chan LS, Shekelle P, et al. Role of antibiotics in AOM. Pediatrics. 2001;108(2):239–247.
Suzuki HG, Dewez JE, Nijman RG, et al. European guidelines AOM. BMJ Open. 2020;10(5):e035343.
Castelli Gattinara G, Bergamini M, Simeone G, et al. Italian consensus antibiotics AOM. Italian Journal of Pediatrics. 2025;51(1):50.
Spoială EL, Stanciu GD, Bild V, et al. Evidence to guidelines antibiotic AOM. Antibiotics. 2021;10(1):52. doi:10.3390/antibiotics10010052
Petel DS, Cheong L, Harvey G, et al. Antibiotic prescribing practices AOM. Open Forum Infectious Diseases. 2025;12(Supplement_1).
Rothman S, Pitaro J, Hackett A, et al. Treatment AOM ED. Pediatric Infectious Disease Journal. 2018;37(6):520–525.
Smolinski NE, Djabali EJ, Al-Bahou J, et al. Antibiotics prevent complications AOM. PLOS ONE. 2024;19(6):e0304742. doi:10.1371/journal.pone.0304742
Morin TL, Stein AB, El Feghaly RE, et al. Minimizing unnecessary antibiotic use. Children. 2025;12(10):1408. doi:10.3390/children12101408
Katz SE, Jenkins TC, Stein AB, et al. Antibiotic duration variability. Journal of the Pediatric Infectious Diseases Society. 2024;13(9):455–465. doi:10.1093/jpids/piae073
Cushen R, Francis NA. Antibiotic use and complications. British Journal of General Practice. 2020;70(693):e255–e263. doi:10.3399/bjgp20X708821
Reale M, Montagnani C, Orlando P, et al. Acute mastoiditis management. Italian Journal of Pediatrics. 2025;51(1):272.
Marchisio P, Bortone B, Ciarcià M, et al. Italian AOM Guidelines. Pediatric Infectious Disease Journal. 2019;38(12S):S22–S36.
Chiappini E, Marchisio P. Italian AOM Guidelines. Pediatric Infectious Disease Journal. 2019;38(12S):S1–S2.
Setiawan EP, Rahayu ML, Saputra KAD, et al. Risk factors and management for AOM. GSC Advanced Research and Reviews. 2025;23(3):48–55.
Leach AJ, Morris PS, Coates HL, et al. Otitis media guidelines Aboriginal children. Medical Journal of Australia. 2021;214(5):228–233.
Granath A. Recurrent Acute Otitis Media. Current Otorhinolaryngology Reports. 2017;5(2):93–100.
Referanslar
Węgrzyn J, Fijałkowski Ł, Nosal A, et al. Acute Otitis Media in children – a review of current literature. Journal of Education, Health and Sport. 2025;79:57781.
Goldman RD. Acute otitis media in children 6 months to 2 years of age. Canadian Family Physician. 2022;68(8):589–590.
Parmanand K, Atfeh M. Acute otitis media. InnovAiT: Education and Inspiration for General Practice. 2023;16(8):381–386.
Wang H, Zeng X, Miao X, et al. Global, regional, and national epidemiology of otitis media in children from 1990 to 2021. Frontiers in Pediatrics. 2025;13. doi:10.3389/fped.2025.1513629
Sigurdsson S, Eythorsson E, Hrafnkelsson B, et al. Reduction in All-Cause Acute Otitis Media in Children <3 Years of Age in Primary Care Following Vaccination With 10-Valent Pneumococcal Haemophilus influenzae Protein-D Conjugate Vaccine. Clinical Infectious Diseases. 2018;67(8):1213–1219. doi:10.1093/cid/ciy233
Ricci Conesa H, Skröder H, Norton N, et al. Clinical and economic burden of acute otitis media caused by Streptococcus pneumoniae in European children. PLOS ONE. 2024;19(4):e0297098. doi:10.1371/journal.pone.0297098
Sirota SB, Doxey MC, Dominguez RMV, et al. Global burden of upper respiratory infections and otitis media, 1990–2021. The Lancet Infectious Diseases. 2025;25(1):36–51. doi:10.1016/S1473-3099(24)00430-4
Mariam S, Elmehdi EAMSAM, Lassana K, et al. Epidemiological Profiles of Acute Otitis Media. International Journal of Otorhinolaryngology. 2024;10(1):1–5.
Samaké L, Ahmadou D, Kalifa O, et al. Epidemiological, Clinical and Therapeutic Aspects of Acute Otitis Media. SAS Journal of Surgery. 2023;9(03):162–166.
Kaur R, Fuji N, Pichichero ME. Dynamic changes in otopathogens after PCV13 vaccination. European Journal of Clinical Microbiology & Infectious Diseases. 2022;41(1):37–44. doi:10.1007/s10096-021-04324-0
Tzovara I, Doudoulakakis A, Kalogeras G, et al. Bacterial Acute Otitis Media with Otorrhea. Pathogens. 2025;14(5):494.
Fuji N, Salamone FN, Kaur R, et al. Longitudinal Study of Acute Otitis Media During PCV Era. Journal of Infectious Diseases. 2025;232(2):417–429.
Kaur R, Schulz S, Sherman A, et al. Higher-valency PCV effects. Pediatric Infectious Disease Journal. 2024;43(10):1004–1010.
Dissanayake G, Zergaw M, Elgendy M, et al. Pneumococcal Vaccines and Resistant AOM. Cureus. 2024.
Setiawan EP, Rahayu ML, Saputra KAD, et al. Risk factors and management for AOM. GSC Advanced Research and Reviews. 2025;23(3):48–55.
Folino F, Caruso M, Bosi P, et al. AOM diagnosis in childhood. Italian Journal of Pediatrics. 2024;50(1):19.
Carson JJK, Urbach N, Leifso K. Otoscopy guideline adherence. Paediatrics & Child Health. 2025.
El Feghaly RE, Nedved A, Katz SE, et al. Treatment of AOM. Expert Review of Anti-Infective Therapy. 2023;21(5):523–534. doi:10.1080/14787210.2023.2206565
Surapaneni S, Rangarajan N, Davis K, et al. Deep learning classifier. Otolaryngology–Head and Neck Surgery. 2025;173(6):1485–1493.
Crowson MG, Hartnick CJ, Diercks GR, et al. Machine Learning Effusion Diagnosis. Pediatrics. 2021;147(4)
Shaikh N, Conway SJ, Kovačević J, et al. Automated classifier AOM. JAMA Pediatrics. 2024;178(4):401.
Esposito S, Bianchini S, Argentiero A, et al. Technologies to improve diagnosis. Diagnostics. 2021;11(12):2392.
Cai Y, Yu JG, Chen Y, et al. CNN diagnosis otitis media. BMJ Open. 2021;11(1):e041139.
Mousseau S, Lapointe A, Gravel J. Smartphone otoscope RCT. American Journal of Emergency Medicine. 2018;36(10):1796–1801.
Sundgaard JV, Harte J, Bray P, et al. Deep metric learning. Medical Image Analysis. 2021;71:102034.
El Feghaly RE, Nedved A, Katz SE, et al. Treatment of AOM. Expert Review of Anti-Infective Therapy. 2023;21(5):523–534. doi:10.1080/14787210.2023.2206565
McCormick DP, Grady JJ, Diego A, et al. AOM severity and risk factors. International Journal of Pediatric Otorhinolaryngology. 2011;75(5):708–712.
Venekamp RP, Sanders SL, Glasziou PP, et al. Antibiotics for AOM. Cochrane Database of Systematic Reviews. 2023(12).
Ali I, Akram A, Mangrio SAN, et al. Immediate vs delayed antibiotics. Pakistan Journal of Medical and Health Sciences. 2023;17(11):207–209
Takata GS, Chan LS, Shekelle P, et al. Role of antibiotics in AOM. Pediatrics. 2001;108(2):239–247.
Suzuki HG, Dewez JE, Nijman RG, et al. European guidelines AOM. BMJ Open. 2020;10(5):e035343.
Castelli Gattinara G, Bergamini M, Simeone G, et al. Italian consensus antibiotics AOM. Italian Journal of Pediatrics. 2025;51(1):50.
Spoială EL, Stanciu GD, Bild V, et al. Evidence to guidelines antibiotic AOM. Antibiotics. 2021;10(1):52. doi:10.3390/antibiotics10010052
Petel DS, Cheong L, Harvey G, et al. Antibiotic prescribing practices AOM. Open Forum Infectious Diseases. 2025;12(Supplement_1).
Rothman S, Pitaro J, Hackett A, et al. Treatment AOM ED. Pediatric Infectious Disease Journal. 2018;37(6):520–525.
Smolinski NE, Djabali EJ, Al-Bahou J, et al. Antibiotics prevent complications AOM. PLOS ONE. 2024;19(6):e0304742. doi:10.1371/journal.pone.0304742
Morin TL, Stein AB, El Feghaly RE, et al. Minimizing unnecessary antibiotic use. Children. 2025;12(10):1408. doi:10.3390/children12101408
Katz SE, Jenkins TC, Stein AB, et al. Antibiotic duration variability. Journal of the Pediatric Infectious Diseases Society. 2024;13(9):455–465. doi:10.1093/jpids/piae073
Cushen R, Francis NA. Antibiotic use and complications. British Journal of General Practice. 2020;70(693):e255–e263. doi:10.3399/bjgp20X708821
Reale M, Montagnani C, Orlando P, et al. Acute mastoiditis management. Italian Journal of Pediatrics. 2025;51(1):272.
Marchisio P, Bortone B, Ciarcià M, et al. Italian AOM Guidelines. Pediatric Infectious Disease Journal. 2019;38(12S):S22–S36.
Chiappini E, Marchisio P. Italian AOM Guidelines. Pediatric Infectious Disease Journal. 2019;38(12S):S1–S2.
Setiawan EP, Rahayu ML, Saputra KAD, et al. Risk factors and management for AOM. GSC Advanced Research and Reviews. 2025;23(3):48–55.
Leach AJ, Morris PS, Coates HL, et al. Otitis media guidelines Aboriginal children. Medical Journal of Australia. 2021;214(5):228–233.
Granath A. Recurrent Acute Otitis Media. Current Otorhinolaryngology Reports. 2017;5(2):93–100.
