Click here to load reader

akut otitis media akut otitis media

  • View
    351

  • Download
    0

Embed Size (px)

Text of akut otitis media akut otitis media

  • Prof. Dr. Ergin FT

    Ankara niversitesi Tp Fakltesi ocuk Enfeksiyon Hastalklar Bilim Dal

    www.erginciftci.com

    YEN KILAVUZLAR ELNDE OTT TANI VE TEDAVS

  • OTTKulan Hangi Blm?

    KULAK

  • OTTS MEDABir Hastaln ki Yz

    AKUT OTTS MEDA EFFZYONLU OTTS MEDA

  • AAP (2004) AAP (2013)

    AKUT OTTS MEDA Klavuz

  • Hibir ey, grnd gibi kolay deildir.

    AKUT OTTS MEDA AKUT OTTS MEDA

    AKUT OTTS MEDAKlavuz

  • AKUT OTTS MEDAKlavuz

    American Academy of Pediatrics. Diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999

    AAP (2013)

  • AKUT OTTS MEDA AKUT OTTS MEDA

    AKUT OTTS MEDABir ocukluk a Hastal

    ocuklarda doktora bavurularn ve antibiyotik kullanmnn en nemli nedeni

    ocuklarn %80den fazlas 3 yaa dek en az bir otit ata geirir.

    En sk 6-24 aylar arasnda grlr.

    Pik insidans: 9-15 ay

  • ERKNDEKNE GRE;

    Daha horizontal

    Daha ksa

    Kkrdak miktar ve sertlii daha az

    Nazofarenkse ald blgede adenoid

    hipertrofisi

    Adenoidlerin enfeksiyon kayna olmas

    AKUT OTTS MEDA AKUT OTTS MEDA

    AKUT OTTS MEDAocuklarda staki Tpnn zellikleri

    ifti E. Akut otitis mediada tan ve tedavi yaklamlar.Reform Solunum Yolu Enfeksiyonlar Blteni, 9-16 (2008).

  • AKUT OTTS MEDA AKUT OTTS MEDA

    AKUT OTTS MEDATanm

    Orta kulan akut balangl, efzyon ve

    inflamasyonla seyreden enfeksiyonudur.

    ifti E. Akut otitis mediada tan ve tedavi yaklamlar.Reform Solunum Yolu Enfeksiyonlar Blteni, 9-16 (2008).

  • AAP (2004) AAP (2004)

    AKUT OTTS MEDA Klavuz

    Semptomlarn akut balamas (Kulak ars, ate...)

    +

    Orta kulakta inflamasyon

    +

    Orta kulak svs

    American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media.Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451-65.

  • Ate

    Huzursuzluk

    Genel hastalk hali

    shal, kusma

    Kulan ekitirme

    BEBEK

    Ate

    Kulak ars

    Kulakta dolgunluk hissi

    Genel hastalk hali

    Ba dnmesi

    itme bozukluu

    OCUK

    AKUT OTTS MEDAAkut Balayan Semptomlar

    Spiro D, Arnold D. The concept and practice of a wait and see approach to acute otitis media. Curr Opin Pediatr 2008; 20: 7278

  • AAP (2004) AAP (2004)

    AKUT OTTS MEDA Klavuz

    Semptomlarn akut balamas (Kulak ars, ate...)

    +

    Orta kulakta inflamasyon

    +

    Orta kulak svs

    American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media.Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451-65.

  • nce

    Yar saydam

    Arkasnda kemikler grlebilir

    Ntral yerleimli

    Hareketli

    NORMAL KULAK ZARI NORMAL KULAK ZARI

    AKUT OTTS MEDANormal Kulak Zar

  • NORMAL KULAK ZARI

    AKUT OTTS MEDANormal Kulak Zar

    NORMAL KULAK ZARI

  • AKUT OTTS MEDAOtoskopik Bulgular

    Kulak zarnda kzarklk

    Grimsi beyaz veya sar renk

    Kabarklk (malleusun grlmesi engellenir)

    Membran perforasyonu ve prlan aknt

    Nadir olarak membranda bller

    Bazen hava-sv veya hava-p seviyesi

    Hareketliliin azalmas

    AKUT OTTS MEDA AKUT OTTS MEDA

  • AKUT OTTS MEDA NORMAL

    AKUT OTTS MEDAOtoskopik Bulgular

  • AKUT OTTS MEDA NORMAL

    AKUT OTTS MEDAOtoskopik Bulgular

  • AKUT OTTS MEDA NORMAL

    AKUT OTTS MEDAOtoskopik Bulgular

  • AKUT OTTS MEDA NORMAL

    AKUT OTTS MEDAOtoskopik Bulgular

  • AAP (2004) AAP (2004)

    AKUT OTTS MEDA Klavuz

    Semptomlarn akut balamas (Kulak ars, ate...)

    +

    Orta kulakta inflamasyon

    +

    Orta kulak svs

    American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media.Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451-65.

  • PNMOTK OTOSKOP PNMOTK OTOSKOP

    AKUT OTTS MEDAPnmotik Otoskopik Muayene

  • TMPANOMETR

    AKUT OTTS MEDA Timpanometri

    Tip A

    Tip B

    Tip C

    TMPANOMETR

  • AKUT OTTS MEDA NORMAL

    AKUT OTTS MEDAOtoskopide Sv ve Bombeleme

  • iddetli enfeksiyon; Ate 39C

    Orta-iddetli kulak ars

    BEKLE-GR YAKLAIMININ UYGULANMASI

    AKUT OTTS MEDATans Kesin Olmayan AOM

    American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media.Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451-65.

  • AAP (2004) AAP (2013)

    AKUT OTTS MEDA Klavuz

    Otit tansn kesinletir!Kesin olmayan Otit tans koyabilirsin

  • AKUT OTTS MEDA

    AKUT OTTS MEDATanm

    Normal Hafif Orta Ar

    American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999

  • AKUT OTTS MEDA

    AKUT OTTS MEDATanm

    Normal Hafif Orta Ar

    Kulak zarnda orta ya da ar bombeleme veya yeni gelien otore (akut otitis eksternaya bal olmayan)

    American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999

  • AKUT OTTS MEDA

    AKUT OTTS MEDATanm

    Normal Hafif Orta ArKulak zarnda hafif bombeleme

    veYeni balayan (< 48 saat) kulak ars (kk bebeklerde kulan tutma, ekme, ovuturma)veyaKulak zarnda youn eritem

    American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999

  • AKUT OTTS MEDA

    AKUT OTTS MEDATanm

    Normal Hafif Orta Ar

    Orta kulakta sv olmayan hastalara AOM tans konulmamaldr.

    Pnmotik otoskopi ve/veya timpanometri ile gsterilmi orta kulak svs

    American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999

  • AKUT OTTS MEDAAr Tedavisi

    AKUT OTTS MEDA

    American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999

  • NorfloksasinSiprofloksasinEnoksasinFleroksasinLomefloksasinOfloksasinLevofloksasinRufloksasin

    SparfloksasinTosufloksasinGatifloksasin PazufloksasinGrepafloksasin

    ALIILMI ETKENLER

    S. pneumoniaeH. influenzaeM. catarrhalis

    S. aureusE. coliKlebsiellaPseudomonas

    SIK OLMAYAN ETKENLER

    M. pneumoniaeC. trachomatisM. tuberculosisA. otitidis

    PeptostreptokokFusobacteriumBacteroides

    RSVRhinovirusnfluenzaParainfluenza AdenovirusEnteroviruslarCMVHSV

    ANAEROBETKENLER

    VRALETKENLER

    AKUT OTTS MEDAEtkenler

    ifti E. Akut otitis mediada tan ve tedavi yaklamlar.Reform Solunum Yolu Enfeksiyonlar Blteni, 9-16 (2008).

  • ETKENLER

    21

    S. pneumoniae

    H. influenzae

    3

    M. catarrhalis

    AKUT OTTS MEDAEtkenler ve Diren Durumu

    zdemir H, ifti E, Durmaz R et al. Nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish children after the addition of PCV7 to the national vaccine schedule. Eur J Pediatr 2014; 173:313320.

    DREN DURUMU

  • ETKENLER

    21

    S. pneumoniae

    H. influenzae

    3

    M. catarrhalis

    AKUT OTTS MEDAEtkenler ve Diren Durumu

    Gr D. Et al. Antibacterial Resistance Among Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalisfrom Kuwait and 5 centres in Turkey: Results from the Survey of Antibiotic Resistance (SOAR) 2007-2009.

    The great majority of isolates of S.pneumoniae, H.influenzae and M.catarrhalis yet remain susceptible to amoxicillin/clavulanate in all centresstudied in Turkey.

    DREN DURUMU

  • Hollanda, sve, ngilterede baaryla

    uyguland bildirildi

    Antibiyotik kullanm daha az

    Antibiyotik direnci daha az

    Mastoidit skl daha fazla

    Giderek daha fazla benimsenmeye baland

    ANTBYOTKSZ DZELME BEKLE-GR YAKLAIMI

    AKUT OTTS MEDAAntibiyotik ver ve Bekle-gr Yaklamlar

    ifti E. Akut otitis mediada tan ve tedavi yaklamlar.Reform Solunum Yolu Enfeksiyonlar Blteni, 9-16 (2008).

    H. influenzae%52

    M. catarrhalis%75

    S. pneumoniae%11

  • DDETL ENFEKSYON; Ate 39C

    Orta-iddetli kulak ars

    BEKLE-GR YAKLAIMININ UYGULANMASI

    AKUT OTTS MEDABekle-gr Yaklam

    American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media.Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451-65.

  • AKUT OTTS MEDATedavi Klavuzlar

    AAP 2013

    American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999

  • DDETL SEMPTOMLAR; Ate 39COrta-iddetli kulak ars48 saatten uzun sreli kulak arsToksik grnen ocukzlem yaplabileceinin kesin olmamas

    BEKLE-GR YAKLAIMININ UYGULANMASI

    AKUT OTTS MEDABekle-gr Yaklam

    American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999

  • AKUT OTTS MEDAHangi Antibiyotik?

    YEN ANTBYOTK SINIFLARININ GELM

    ifti E. Kinolonlar. 30. Pediatri Gnleri, stanbul, 14 Nisan 2008.

  • AKUT OTTS MEDATedavi

    AMOKSSLN30 gn iinde amoksisilin almamPrlan konjunktivit yok

    AMOKSSLN-KLAVULONAT30 gn iinde amoksisilin almPrlan konjunktivit varAmoksisilin yantsz AOM yks var

    TEDAV

    American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999

  • AKUT OTTS MEDATedavi

    TEDAV

    American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999

  • AKUT OTTS MEDATedavi

    TEDAV

    American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999

    TEDAV BAARISIZLII48-72 saat iinde

    Dzelme olmamasDaha ktleme olmas