|
#16
11.02.2009, 19:54
|
||||
|
||||
|
Я так понимаю, что в России, диагноз острого среднего отита ставит не педиатр, а ЛОР-врач. Без отоскопии, которой большинство наших педиатров не владеет, диагноз поставить действительно трудно.
Что касается стадии среднего отита, то нельзя утверждать, что катаральный не требует назначения антибиотиков, а требует только гнойный. Я на данный момент работаю со взрослыми пациентами, хотя имею опыт работы с детьми. В любом случае с удовольствием приму участие в дискуссиях по детской отоларингологии.  
|
|
#17
11.02.2009, 22:14
|
||||
|
||||
|
Цитата:
Цитата:
Я хотел поднять тему тимпаноцентаза (миринготомии, парацентеза - как угодно будет). Согласитесь, тут тактика разная при катаральном и гнойном. Хотя как говорят наши корифеи - парацентез до 3-х лет 100% делать но тут можно тоже много дискутировать и спорить.Цитата:
Давайте пообсуждаем типаноцентез. Гвидлайны щас как поднимем
|
|
#18
13.02.2009, 14:08
|
||||
|
||||
|
О, я тоже сейчас прохожу первичку по сурдологии
 Что касается тимпаноцентеза и миринготомии, вот первое что попалось... EVIDENCE-BASED OTITIS MEDIA SECOND EDITION Richard M. Rosenfeld, MD, MPH Charles D. Bluestone, MD 2003 Table 14-1 Indications for Tympanocentesis* 1. OM in children who have severe otalgia, are seriously ill, or appear toxic 2. Unsatisfactory response to antimicrobial therapy 3. Onset of OM in a patient who is receiving antimicrobial therapy 4. OM associated with a confirmed or potential suppurative complication 5. OM in a newborn, sick neonate, or immunologically deficient patient, any of whom might harbor an unusual organism Two well-designed and executed clinical trials convincingly demonstrated no difference in outcome by adding myringotomy. Englehard and colleagues16 randomized 105 Israeli children to receive amoxicillinclavulanate, amoxicillin-clavulanate and myringotomy, or myringotomy and placebo. Both antibiotic groups were more effective than myringotomy without antibiotic, and there was no statistical advantage found by adding myringotomy to the antibiotic Several other studies have also found no benefit from adding myringotomy to antibiotic therapy as compared with antibiotic therapy alone. Nevertheless,myringotomy is indicated to relieve severe otalgia, when suppurative complications are present or suspected, or at any time a tympanocentesis is warranted
|
|
#19
13.02.2009, 21:16
|
||||
|
||||
|
Эту инфу недавно постил в гем. разделе:
Железодефицитная анемия может быть причиной рецидивирующего среднего отита у детей 0,5-4 года: чем ниже уровень гемоглобина, тем больше число рецидивов в год, коррекция анемии приводила к снижению частоты рецидивов у большинства детей: The association between iron-deficiency anemia and recurrent acute otitis media. Golz A, Netzer A, Goldenberg D, Westerman ST, Westerman LM, Joachims HZ. Am J Otolaryngol. 2001 Nov-Dec;22(6):391-4. Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center and the Faculty of Medicine, Haifa, Israel. PURPOSE: This study was designed to examine the association between iron-deficiency anemia and the frequency of recurrent acute otitis media in children, and to evaluate the effect of restoring normal hemoglobin levels on the frequency of acute otitis media attacks. MATERIALS AND METHODS: A total of 680 children with frequent episodes of acute otitis media were enrolled in the study. The levels of the hemoglobin were measured in both these children and in 200 healthy children with no history of infections. All children with hemoglobin levels lower than 9.5 g/dL received iron supplementation until they reached a level of at least 11 g/dL, and the subsequent frequency of middle ear infections was recorded. RESULTS: The 680 children had an average of 8.3 +/- 2.7 episodes of acute otitis media per year per child, and an average hemoglobin level of 11.4 +/- 2.7 g/dL, whereas the controls had an average hemoglobin level of 13.1 +/- 2.5 g/dL. Twenty percent had hemoglobin levels below 9.5 g/dL. These children had more episodes of acute otitis media when compared with children with average levels. By increasing the hemoglobin level in these children, the frequency of the episodes of acute otitis media decreased significantly.
|
Линейный вид
