medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-8-32-37medsovet-1820Research ArticleИНФЕКЦИИ В ОТОРИНОЛАРИНГОЛОГИИINFECTIONS IN OTORHINOLARYNGOLOGYДИАГНОСТИЧЕСКИЙ И ТЕРАПЕВТИЧЕСКИЙ АЛГОРИТМ ДЛЯ ОСТРОГО СРЕДНЕГО ОТИТАDIAGNOSTIC AND THERAPEUTIC ALGORITHMFOR ACUTE OTITIS MEDIAКирдееваА. И.KirdeevaA. I.

Москва

Moscow

КосяковС. Я.KosyakovS. Y.

Доктор медицинских наук,  профессор.

Москва

MD, Prof.

Moscow

Российская медицинская академия непрерывного постдипломного образованияРоссияRussian Medical Academy of Continuous Postgraduate EducationRussian Federation201712052017083237Copyright © Кирдеева А.И., Косяков С.Я., 20172017Кирдеева А.И., Косяков С.Я.Kirdeeva A.I., Kosyakov S.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1820

Острый средний отит – это остро развившееся воспаление полостей среднего уха, проявляющееся одним или несколькими характерными симптомами (боль в ухе, повышение температуры, выделения из уха, снижение слуха, у детей – возбуждение, раздражительность, рвота, понос). Использование клинических рекомендаций,  основанных на принципах доказательной медицины, позволяет точно диагностировать заболевание и избежать необоснованного назначения антибактериальных препаратов. К методам инструментальной диагностики острого среднего отита относят пневматическую отоскопию, тимпанометрию  и спектральную  акустическую  градиентную рефлектометрию.  Антибактериальная и симптоматическая терапия, включающая анальгетики, антипиретики, нивелирует общие и местные симптомы заболевания в течение 48–72 ч.

Acute otitis media is acutely developed inflammation of the middle ear cavities manifested by one or more characteristic symptoms (earache, fever, discharge from ear, hearing loss in children excitement, irritability, vomiting, diarrhea). The use of clinical guidelines based on the principles of evidence-based  medicine allows accurately diagnosing the disease  and avoiding the unnecessary use of antibiotics. Methods of instrumental diagnostics of acute otitis media include pneumatic otoscopy, tympanometry and spectral gradient acoustic reflectometry. Antibacterial and symptomatic treatment, including analgesics, antipyretics, eliminates the general and local symptoms within 48-72  h.

острый средний отитклинические рекомендацииотоскопияособенности антибактериальной терапии у детейacute otitis mediaclinical guidelinesotoscopypeculiarities of antibacterial therapy in childrenReferencesMonasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, Domenico Grasso,Chiara Barbiero,Giorgio Tamburlini. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One, 2012, 7: e36226.Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, Domenico Grasso,Chiara Barbiero,Giorgio Tamburlini. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One, 2012, 7: e36226.Liese JG, Silfverdal SA, Giaquinto C, Carmona A, Larcombe JH, Garcia-Sicilia J. Incidence and clinical presentation of acute otitis media in children aged / 6 years in European medical practices. Epidemiology & Infection, 2014, 142(8): 1778-88.Liese JG, Silfverdal SA, Giaquinto C, Carmona A, Larcombe JH, Garcia-Sicilia J. Incidence and clinical presentation of acute otitis media in children aged / 6 years in European medical practices. Epidemiology & Infection, 2014, 142(8): 1778-88.Косяков С.Я., Лопатин А.С. Современные принципы лечения острого среднего, затянувшегося и рецидивирующего острого среднего отита. РМЖ, 2002, 20: 903.Косяков С.Я., Лопатин А.С. Современные принципы лечения острого среднего, затянувшегося и рецидивирующего острого среднего отита. РМЖ, 2002, 20: 903.Teele DW, Klein JO, Rosner BA. Epidemiology of otitis media in children. Annals of Otology, Rhinology & Laryngology, 1980, 89: 5.Teele DW, Klein JO, Rosner BA. Epidemiology of otitis media in children. Annals of Otology, Rhinology & Laryngology, 1980, 89: 5.Schwartz RH, Rodriguez WJ, Brook I, Grundfast KM. The febrile response in acute otitis media. JAMA, 1981, 245: 2057.Schwartz RH, Rodriguez WJ, Brook I, Grundfast KM. The febrile response in acute otitis media. JAMA, 1981, 245: 2057.Hayden GF, Schwartz RH. Characteristics of earache among children with acute otitis media. The American Journal of Diseases of Children, 1985, 139: 721.Hayden GF, Schwartz RH. Characteristics of earache among children with acute otitis media. The American Journal of Diseases of Children, 1985, 139: 721.Ellen R Wald, MD. Acute otitis media in children: Diagnosis. UptoDate, Nov 2016.Ellen R Wald, MD. Acute otitis media in children: Diagnosis. UptoDate, Nov 2016.Karma PH, Sipila MM, Kayaja MJ, Penttila MA. Pneumatic otoscopy and otitis media: The value of different tympanic membrane findings and their combinations. In: Recent advances in otitis media: proceedings of the Fifth International Symposium, Lim DJ, Bluestone CD, Klein JO, et al (Eds), Decker, Burlington, Ontario 1993: 41.Karma PH, Sipila MM, Kayaja MJ, Penttila MA. Pneumatic otoscopy and otitis media: The value of different tympanic membrane findings and their combinations. In: Recent advances in otitis media: proceedings of the Fifth International Symposium, Lim DJ, Bluestone CD, Klein JO, et al (Eds), Decker, Burlington, Ontario 1993: 41.Pichichero ME. Otitis media. Pediatric Clinics of North America, 2013, 60(2): 391-407.Pichichero ME. Otitis media. Pediatric Clinics of North America, 2013, 60(2): 391-407.Heikkinen T, Ruuskanen O. Temporal development of acute otitis media during upper respiratory tract infection. The Pediatric Infectious Disease Journal, 1994, 13(7): 659-661.Heikkinen T, Ruuskanen O. Temporal development of acute otitis media during upper respiratory tract infection. The Pediatric Infectious Disease Journal, 1994, 13(7): 659-661.Shand KD, PA-C and Kristin Campe, PA-C, LCSW. Innovative technologies in diagnosing acute otitis media. American Academy of Physician Assistants, 2016, 29(1): 37-41.Shand KD, PA-C and Kristin Campe, PA-C, LCSW. Innovative technologies in diagnosing acute otitis media. American Academy of Physician Assistants, 2016, 29(1): 37-41.Kaleida PH. The COMPLETES exam for otitis. International Journal of Contemporary Pediatrics, 1997, 14: 93.Kaleida PH. The COMPLETES exam for otitis. International Journal of Contemporary Pediatrics, 1997, 14: 93.Chonmaitree T. Acute otitis media is not a pure bacterial disease. Clinical Infectious Diseases, 2006, 43: 1423.Chonmaitree T. Acute otitis media is not a pure bacterial disease. Clinical Infectious Diseases, 2006, 43: 1423.Leibovitz E, Asher E, Piglansky L, Givon-Lavi N, Satran R, Raiz S, Slovik Y, Leiberman A, Dagan R. Is bilateral acute otitis media clinically different than unilateral acute otitis media? The Pediatric Infectious Disease Journal, 2007, 26: 589.Leibovitz E, Asher E, Piglansky L, Givon-Lavi N, Satran R, Raiz S, Slovik Y, Leiberman A, Dagan R. Is bilateral acute otitis media clinically different than unilateral acute otitis media? The Pediatric Infectious Disease Journal, 2007, 26: 589.Palmu AA, Herva E, Savolainen H, Karma P, Mäkelä PH, Kilpi TM. Association of clinical signs and symptoms with bacterial findings in acute otitis media. Clinical Infectious Diseases, 2004, 38: 234.Palmu AA, Herva E, Savolainen H, Karma P, Mäkelä PH, Kilpi TM. Association of clinical signs and symptoms with bacterial findings in acute otitis media. Clinical Infectious Diseases, 2004, 38: 234.Rodriguez WJ, Schwartz RH. Streptococcus pneumoniae causes otitis media with higher fever and more redness of tympanic membranes than Haemophilus influenzae or Moraxella catarrhalis. The Pediatric Infectious Disease Journal, 1999, 18: 942.Rodriguez WJ, Schwartz RH. Streptococcus pneumoniae causes otitis media with higher fever and more redness of tympanic membranes than Haemophilus influenzae or Moraxella catarrhalis. The Pediatric Infectious Disease Journal, 1999, 18: 942.Jerome O Klein, MD Stephen Pelton, MD. Acute otitis media in children: Epidemiology, microbiology, clinical manifestations, and complications. UptoDate, Nov 2016.Jerome O Klein, MD Stephen Pelton, MD. Acute otitis media in children: Epidemiology, microbiology, clinical manifestations, and complications. UptoDate, Nov 2016.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. The Pediatric Infectious Disease Journal, 2002, 21: 669.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. The Pediatric Infectious Disease Journal, 2002, 21: 669.Turner D1, Leibovitz E, Aran A, Piglansky L, Raiz S, Leiberman A, Dagan R. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet, 2006, 368: 1429.Turner D1, Leibovitz E, Aran A, Piglansky L, Raiz S, Leiberman A, Dagan R. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet, 2006, 368: 1429.Teele DW, Klein JO, Rosner BA. Epidemiology of otitis media in children. Annals of Otology, Rhinology & Laryngology, 1980, 89: 5.Teele DW, Klein JO, Rosner BA. Epidemiology of otitis media in children. Annals of Otology, Rhinology & Laryngology, 1980, 89: 5.Questions & Answers: Reports of a rare, but serious and potentially fatal adverse effect with the use of over-the-counter (OTC) benzocaine gels and liquids applied to the gums or mouth www.fda.gov/Drugs/DrugSafety/ucm250029.htm (Accessed on August 03, 2012).Questions & Answers: Reports of a rare, but serious and potentially fatal adverse effect with the use of over-the-counter (OTC) benzocaine gels and liquids applied to the gums or mouth www.fda.gov/Drugs/DrugSafety/ucm250029.htm (Accessed on August 03, 2012).Jerome O Klein, Stephen Pelton. Acute otitis media in children: Treatment. UptoDate, Nov 2016.Jerome O Klein, Stephen Pelton. Acute otitis media in children: Treatment. UptoDate, Nov 2016.American Academy of Pediatrics Subcommittee on Management of Acute Otitis and Media, Diagnosis and management of acute otitis media, Pediatrics, 2004 May 5, 113: 1451-1465.American Academy of Pediatrics Subcommittee on Management of Acute Otitis and Media, Diagnosis and management of acute otitis media, Pediatrics, 2004 May 5, 113: 1451-1465.Ganzberg S, Kramer KJ. The use of local anesthetic agents in medicine. Dent. Clin. North Am., 2010 October 4, 54: 601-610.Ganzberg S, Kramer KJ. The use of local anesthetic agents in medicine. Dent. Clin. North Am., 2010 October 4, 54: 601-610.Bolt P, Barnett P, Babl FE, Sharwood LN. Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Archives of Disease in Childhood, 2008, 93(1): 40-4.Bolt P, Barnett P, Babl FE, Sharwood LN. Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Archives of Disease in Childhood, 2008, 93(1): 40-4.Hoberman A, Paradise JL, Reynolds EA, Urkin J. Efficacy of Auralgan for treating ear pain in children with acute otitis media. Archives of Pediatrics & Adolescent Medicine, 1997, 151(7): 675-8.Hoberman A, Paradise JL, Reynolds EA, Urkin J. Efficacy of Auralgan for treating ear pain in children with acute otitis media. Archives of Pediatrics & Adolescent Medicine, 1997, 151(7): 675-8.Hoberman A, Ruohola A, Shaikh N, Tähtinen PA, Paradise JL. Acute otitis media in children younger than 2 years. JAMA Pediatrics, 2013, 167: 1171.Hoberman A, Ruohola A, Shaikh N, Tähtinen PA, Paradise JL. Acute otitis media in children younger than 2 years. JAMA Pediatrics, 2013, 167: 1171.Takata GS, Chan LS, Shekelle P, Morton SC, Mason W, Marcy SM. Evidence assessment of management of acute otitis media: I. The role of antibiotics in treatment of uncomplicated acute otitis media. Pediatrics, 2001, 108: 239.Takata GS, Chan LS, Shekelle P, Morton SC, Mason W, Marcy SM. Evidence assessment of management of acute otitis media: I. The role of antibiotics in treatment of uncomplicated acute otitis media. Pediatrics, 2001, 108: 239.Kozyrskyj A, Klassen TP, Moffatt M, Harvey K. Short-course antibiotics for acute otitis media. The Cochrane Database of Systematic Reviews, 2010, CD001095.Kozyrskyj A, Klassen TP, Moffatt M, Harvey K. Short-course antibiotics for acute otitis media. The Cochrane Database of Systematic Reviews, 2010, CD001095.Spurling GK, Del Mar CB, Dooley L, et al. Delayed antibiotics for respiratory infections. The Cochrane Database of Systematic Reviews, 2013, CD004417.Spurling GK, Del Mar CB, Dooley L, et al. Delayed antibiotics for respiratory infections. The Cochrane Database of Systematic Reviews, 2013, CD004417.Glasziou PP, Del Mar CB, Sanders SL, Hayem M. Antibiotics for acute otitis media in children. The Cochrane Database of Systematic Reviews, 2004, CD000219.Glasziou PP, Del Mar CB, Sanders SL, Hayem M. Antibiotics for acute otitis media in children. The Cochrane Database of Systematic Reviews, 2004, CD000219.Ian A. Critchley, Michael R. Jacobs, Steven D. Brown, Maria M. Traczewski, Glenn S. Tillotson,Nebojsa Janjic. Prevalence of serotype 19A Streptococcus pneumoniae among isolates from U.S. children in 2005-2006 and activity of faropenem. Antimicrobial Agents and Chemotherapy, 2008, 52: 2639.Ian A. Critchley, Michael R. Jacobs, Steven D. Brown, Maria M. Traczewski, Glenn S. Tillotson,Nebojsa Janjic. Prevalence of serotype 19A Streptococcus pneumoniae among isolates from U.S. children in 2005-2006 and activity of faropenem. Antimicrobial Agents and Chemotherapy, 2008, 52: 2639.Pichichero ME. Otitis media. Pediatr Clin North Am, 2013, 60: 391.Pichichero ME. Otitis media. Pediatr Clin North Am, 2013, 60: 391.Hendrickse WA, Kusmiesz H, Shelton S, Nelson JD. Five vs. ten days of therapy for acute otitis media. Pediatr Infect Dis J, 1988, 7: 14.Hendrickse WA, Kusmiesz H, Shelton S, Nelson JD. Five vs. ten days of therapy for acute otitis media. Pediatr Infect Dis J, 1988, 7: 14.Mair EA, Park AH, Don D, Koempel J, Bear M, LeBel C. Safety and Efficacy of Intratympanic Ciprofloxacin Otic Suspension in Children With Middle Ear Effusion Undergoing Tympanostomy Tube Placement Two Randomized Clinical Trials. JAMA Otolaryngology Head Neck Surgery, 2016.Mair EA, Park AH, Don D, Koempel J, Bear M, LeBel C. Safety and Efficacy of Intratympanic Ciprofloxacin Otic Suspension in Children With Middle Ear Effusion Undergoing Tympanostomy Tube Placement Two Randomized Clinical Trials. JAMA Otolaryngology Head Neck Surgery, 2016.

The authors declare that there are no conflicts of interest present.