小児しん出性中耳炎の年齢と治療方針

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  • 高橋 晴雄
    長崎大学大学院医歯薬学総合研究科 病態解析・制御学講座 耳鼻咽喉病態制御学領域

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タイトル別名
  • Strategy for Management of Otitis Media with Effusion in Children Based on Age
  • ショウニシンシュツセイ チュウジエン ノ ネンレイ ト チリョウ ホウシン

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Therapeutic strategy for otitis media with effusion (OME) in children according to age was described. OME in young children under the age of 3 is important in the sense that OME during this period is highly related to the etiology of its sequelae such as cholesteatoma, and should be extensively controlled by various treatments including explaining the harm of day care and tympanostomy tube insertion. Low-dose long-term mefenamic acid is also sometimes effective. OME in children between 4 and 9 years of age generally has a good prognosis, and the treatment, particularly surgical treatment, should be strictly indicated. OME in children over 10 years of age can be regarded as already intractable similar to that in adults, and should be aggressively treated, because this period is the last chance to prevent OMEs from tranforming into sequelae, although the management is not easy. The first thing that we otolaryngologists should do for such patients is to detect particular pathogenetic factors that OME children in this age group often have, such as organic abnormalities in the eustachian tube including obstruction or closing failure, or intractable inflammation in the nasopharynx such as adult-type chronic sinusitis. Low-dose long-term macrolides is sometimes effective for these pathologic factors.

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