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

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