最新Otitis media with effusion（医学课件）.pptVIP

Managements Non surgical treatment Antibiotics Steroid Improvement of nose congestion Managements Surgical treatment Tympanocentesis Myrigotomy Tympanotomy with PT mastoidectomy Management of AOMalternative medical treatment Corticosteroid (orally or intranasally), Antihistamine, decongestants Orally corticosteroid and intranasally corticosteroid help clear chronic middle ear effusion. However, there is no evidence of efficacy in treatment of AOM. Antihistamine and decongestants are used in the treatment of OME, it does not benefit AOM. Children who have nasal congestion and allergic rhinitis there may be a role for these preparation. Otitis media with effusion The nature history of this disease is for spontaneous resolution in the majority of case More the 80% resolution by 2 month. It is the small number of children who continue to have effusion after 2-3 months that are concern. A trial of antibiotics would be appear to be appropriate in those children who have not received antibiotics recently. OME is probably underdiagnosis. Otitis media with effusion Chronic OME is defined as an effusion persisting for more than 3 months duration. A dense effusion typically may confer up to a 30 dB hearing loss. Chronic OME may have a role in development of retraction pockets, ossicular chain erosion, and cholesteatoma formation. Otitis media with effusion Meta-analyses have come to conclusion that antibiotics have a small but distinct advantage over placebo in the treatment of persistent OME. When the effusion is chronic, surgical intervention should be considered, especially when antibiotic therapy fail. The primary surgical therapy remains placement of tympanostomy tubes for pressure equalization and drainage of middle ear. Surgical treatment for otitis media Placement of tympanostomy tubes. Middle ear effusion for more than 3 months or more. OME associated with hearing loss of 30dB Chronic severe TM retraction. Impending intracranial complication Recurrent otitis media