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Akut mediaotit (AOM)

Senast uppdaterad: Senast reviderad:


Definition:
En akut infektion i mellanörats slemhinnor, ofta efter en övre luftvägsinfektion.
Förekomst:
AOM är den vanligaste bakterieinfektionen hos barn och är mera ovanligt hos vuxna.
Symtom:
Akut öronvärk med snabbt insjuknande, ofta efter en förkylningsperiod, med feber och nedsatt allmäntillstånd.
Kliniska fynd:
Purulent flytning i hörselgång vid spontanperforation, form- och färgförändrad trumhinna med upphävd eller nedsatt rörlighet.
Diagnostik:
Pneumatisk otoskopi och tympanometri kan påvisa upphävd eller nedsatt rörlighet. En ovanlig med viktig komplikation är mastoidit.
Behandling:
Behandling består av högläge, smärstillande/febernedsättande läkemedel och hos vissa grupper antibiotikabehandling.
  1. Rovers MM, Schilder AGM, Zielhuis GA, Rosenfeld RM. Otitis media. Lancet 2004; 363: 465-73. PubMed  
  2. Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician 2007; 76: 1650-8. PubMed  
  3. Klein JO, Pelton S. Acute otitis media in children: Epidemiology, microbiology, clinical manifestations, and complications. UpToDate (2017). www.uptodate.com  
  4. Daly KA, Hoffman HJ, Kvaerner KJ, Kvestad E, et al. Epidemiology, natural history, and risk factors: Panek report from the ninth international research conference on otitis media. Int J Pediatr Otorhinolaryngol 2010; 74: 231-40. PubMed  
  5. Thompson PL, Gilbert RE, Long PF, et al. Effect of antibiotics for otitis media on mastoiditis in children: a retrospective cohort study using the United kingdom general practice research database. Pediatrics 2009; 123: 424-30. Pediatrics  
  6. Arrieta A, Singh J. Management of recurrent and persistent acute otitis media: new options with familiar antibiotics. Pediatr Infect Dis J 2004; 23(2 suppl): 115-24. PMID: 14770074 PubMed  
  7. Lindbæk M, Kværner KJ. Behandling av akutt otitis media hos barn. Tidsskr Nor Lægeforen 2004; 124: 2242-3. Tidsskrift for Den norske legeforening  
  8. Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Fam Pract 2008; 25: 233-6. PubMed  
  9. Behandlingsrekommendationer för vanliga infektioner i öppenvård. Smi, Läkemedelsverket, Strama (2013) www.lakemedelsverket.se  
  10. Marcy M, Takata G, Shekelle P, et al. Management of acute otitis media: evidence report/technology assessment no. 15 (prepared by the Southern California Evidence-based Practice Center under contract no. 290-97-0001). AHRQ Publication No. 01-E010. Rockville, MD: Agency for Healthcare Research and Quality, 2001.
  11. Läkemedelsverket (2017). Otit (akut mediaotit - AOM). Behandlingsrekommendation. 2010:(21)5. (Hämtad 2017-07-27) lakemedelsverket.se  
  12. Läkemedelsverket. Uppdatering av behandlingsrekommendation rörotit (2018). medibas.se  
  13. Thanaviratananich S1, Laopaiboon M, Vatanasapt P. Once or twice daily versus three times daily amoxicillin with or without clavulanate for the treatment of acute otitis media. Cochrane Database Syst Rev. 2013 Dec 13;12:CD004975. doi: 10.1002/14651858.CD004975.pub3. DOI  
  14. Venekamp RP,Mick P, Schilder AGM, et al. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD012017. DOI: 10.1002/14651858.CD012017.pub2. cochranelibrary-wiley.com  
  15. Hoberman A, Preciado D, Paradise JL, et al. Tympanostomy Tubes or Medical Management for Recurrent Acute Otitis Media. N Engl J Med. 2021;384(19):1789-1799. PMID:33979487. PubMed  
  16. Pichichero M, Kaur R, Scott DA, et al. Effectiveness of 13-valent pneumococcal conjugate vaccination for protection against acute otitis media caused by Streptococcus pneumoniae in healthy young children: a prospective observational study. Lancet Child Adolesc Health 2018. PMID:30119715. PubMed  
  17. Norhayati MN, Ho JJ, Azman MY. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database of Syst Rev 2015; 3: CD010089. doi:10.1002/14651858.CD010089.pub2 DOI  
  18. Scott AM, Clark J, Julien B et al. Probiotics for preventing acute otitis media in children. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD012941. DOI: 10.1002/14651858.CD012941.pub2. www.cochranelibrary.com  
  19. Paradise JL, Bluestone CD et al. Adenoidectomy and Adenotonsillectomy for Recurrent Acute Otitis Media. Parallell Randomized Clinical Trials in Children Not Previously Treated With Tympanostomy Tubes. JAMA 1999; 282:945-953. Journal of the American Medical Association  
  20. Tähtinen PA, Laine MK, Huovinen P, et al. A placebo-controlled trial of antimicrobial treatment for acute otitis media. N Engl J Med 2011; 364: 116-26. New England Journal of Medicine  
  21. Hoberman A, Paradise JL, Rockette HE,et al. Treatment of acute otitis media in children under 2 years of age. N Engl J Med 2011; 364: 105-15. New England Journal of Medicine  
  22. Venekamp RP, Burton MJ, van Dongen TM, et al. Antibiotics for otitis media with effusion in children. Cochrane Database Syst Rev. 2016 Jun 12;6:CD009163. Cochrane (DOI)  
  23. Venekamp RP, Sanders SL, Glasziou PP, et al. Antibiotics for acute otitis media in children.. Cochrane Database Syst Rev 2015; 6: CD000219. pmid:26099233 PubMed  
  • Remy Waardenburg, specialist i allmänmedicin, Vårdcentralen Hökarängen