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DOI: 10.1055/s-2001-11030
Stand der kontroversen Diskussion um die Pathogenese und Behandlung des chronischen Paukenergusses im Kindesalter
Publication History
Publication Date:
31 December 2001 (online)
Zusammenfassung
Hintergrund: Der chronische Paukenerguss ist mit einer Inzidenz von 10 - 35 % eine der häufigsten Erkrankungen im Kindesalter. Die Ursachen dieses Krankheitsbildes sind in ihrer Gewichtung unklar. Methode: Es erfolgte eine umfangreiche Literaturrecherche zum Stand der Pathogenese und Behandlung des chronischen Paukenergusses in der deutschen und angelsächsischen Literatur. Ergebnisse: Die ursprüngliche Vorstellung eines rein durch die vergrößerte Rachenmandel bedingten mechanischen Hindernisses erscheint aus heutiger Sicht unzureichend. Entzündungsmechanismen, die möglicherweise durch im Paukenerguss nachweisbare, pathogene Keime ausgelöst werden, stehen einer immunmodulatorischen Entstehungstheorie ohne typische Keiminvasion gegenüber. Es gibt weiterhin Hinweise für bei bestimmten Individuen bedeutsame allergische Mechanismen. Die kontroverse Diskussion um die Pathophysiologie des chronischen Paukenergusses findet ihren Ausdruck in den gegensätzlichen Meinungen zum optimalen Behandlungskonzept dieses Krankheitsbildes. Hierzu zählen verschiedene konservative Behandlungsansätze, bei denen vor allem der mögliche Stellenwert einer Antibiotikagabe diskutiert wird. Andere Gruppen empfehlen vor dem Hintergrund eines fehlenden langfristigen Therapieerfolges konservativer Behandlungsverfahren eine abwartende Haltung. Unter den operativen Behandlungsstrategien wird die Bedeutung einer Paukendrainage gegenüber einer Kombinationsbehandlung aus Paukendrainage und Adenotomie hinsichtlich des Langzeitergebnisses kontrovers beurteilt. Schlussfolgerungen: Die ökonomische und soziale Bedeutung dieses Krankheitsbildes macht weiterführende Untersuchungen zur Aufdeckung der Pathophysiologie und Optimierung konservativer ebenso wie operativer Behandlungsstrategien unerlässlich.
Current Standing of the Controversial Discussion of the Aetiopathology and the Treatment of Chronic Otitis Media with Effusion in Children
Background: Chronic otitis media with effusion is one of the most common diseases in childhood. The causes of otitis media are unclear as far as their importance is concerned. Method: Extensive search in the German and Anglo-saxon literature with following presentation of the results. Results: The original idea of a mechanical obstruction of the eustachian tube by the adenoids seems to be insufficient. Inflammatory mechanisms as a result of pathogenic germs in the middle ear fluid stand opposite to immunomodulating mechanisms as relevant causes of chronic otitis media with effusion. There are references which lead to the importance of allergic comechanisms individually. The controversial discussion of the pathophysiology of chronic otitis media with effusion is illustrated by the different opinions of optimal treatment modalities. Varying medical treatment opportunities exist while centrally the importance of the use of antibiotics is controversial. Based on the absence of long lasting effects of medical treatments, there are groups supporting a wait-and-see policy. Concerning the long-term effects of operative treatment, the importance of isolate tubes inseration in opposition to a combined treatment modality (adenotomy and tubes) is controversial. The actual debate focusses on adenotomy or adenotonsillectomy without operating the middle ear as treatment modality in patients with otitis media with effusion. Conclusions: Economic and social importance of this disease forces further investigations in pathogenesis and optimizing of medical and operative treatment modalities.
Schlüsselwörter:
Chronischer Paukenerguss - Antibiotika - Adenoide - Adenotomie - Parazentese - Paukendrainage
Key words:
Chronic otitis media with effusion - Antibiotics - Adenoids - Tubes
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Dr. Anja-A. Dünne
Univ.-HNO-Klinik
Deutschhausstraße 335 037 Marburg
Email: E-mail: duenne@mailer.uni-marburg.de