DGI:Otitis media chronica/Therapie: Difference between revisions

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==Therapie==
==Therapie==


===Otitis media chronica mesotympanalis===
==== Otitis media chronica mesotympanalis ====
<span style="font-family:&quot;Arial&quot;,sans-serif">Bei der Therapie können grundsätzlich zwei Wege eingeschlagen werden.</span>
<span style="font-family:&quot;Arial&quot;,sans-serif">Bei der Therapie können grundsätzlich zwei Wege eingeschlagen werden.</span>


====<span style="font-family:&quot;Arial&quot;,sans-serif">Konservativer Pfad:</span>====
====== <span style="font-family:&quot;Arial&quot;,sans-serif">Konservativer Pfad</span> ======


*<span style="font-family:&quot;Arial&quot;,sans-serif">Im infektfreien Intervall sollte ein Wassereintritt in das betroffene Ohr unbedingt vermieden werden</span>
*<span style="font-family:&quot;Arial&quot;,sans-serif">Im infektfreien Intervall sollte ein Wassereintritt in das betroffene Ohr unbedingt vermieden werden</span>
Line 11: Line 11:
*<span style="font-family:&quot;Arial&quot;,sans-serif">Im akuten, sezernierenden Stadium</span>
*<span style="font-family:&quot;Arial&quot;,sans-serif">Im akuten, sezernierenden Stadium</span>


border:none;mso-border-alt:solid black .5pt;mso-yfti-tbllook:1184;mso-padding-alt:
 
0cm 5.4pt 0cm 5.4pt"
{| class="wikitable  
{| class="wikitable sortable mw-collapsible filterable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="605" style="margin-left:-.25pt;border-collapse:collapse;mso-table-layout-alt:fixed;"
|+
|+
| style="width:70.9pt;" width="95" valign="top" |'''<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">Klinische Situation</span>'''
!Klinische Situation
| style="width:63.8pt;" width="85" valign="top" |'''<span style="color: black">Präferenz</span>'''
!Präferenz
| style="width:77.95pt;" width="104" valign="top" |'''<span style="color: black">Substanz</span>'''
!Substanz
| style="width:3.0cm;" width="113" valign="top" |'''<span style="color: black">Dosierung</span>'''
!Dosierung
| style="width:42.5pt;" width="57" valign="top" |'''<span style="color: black">Dauer</span>'''
!Dauer
| style="width:2.0cm;" width="76" valign="top" |'''<span style="color: black">Anpassungen</span>'''
!Anpassungen
| style="width:2.0cm;" width="76" valign="top" |'''<span style="color: black">Kommentar</span>'''
!Kommentar
|- style="height:27.7ptpx;"
|-
| rowspan="2" style="width:70.9pt;" width="95" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
| rowspan="2" |  
  Arial">Otitis</span> media <span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">chronica</span><span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial;
Otitis media chronica  
  mso-ansi-language:NO-BOK"> </span><span style="font-family:&quot;Arial&quot;,sans-serif;
mesotympanalis
  mso-fareast-font-family:Arial">mesotympanalis</span>
|Therapie der Wahl
| style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
|Lokaltherapie mit Ciprofloxacin Ohrtropfen
  Arial">Therapie der Wahl</span>
|2 x 3-4 Gtt.
| style="width:77.95pt;" width="104" valign="top" |<span style="font-size:11.0pt">Lokaltherapie mit Ciprofloxacin Ohrtropfen</span>
|5 - 7 d
| style="width:3.0cm;" width="113" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
|  -
  Arial">2 x 3-4 Gtt.</span>
|Gefahr von Pilzinfektionen bei längerer Anwendung
| style="width:42.5pt;" width="57" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
|-
  Arial">5-7d</span>
|zusätzlich
| style="width:2.0cm;" width="76" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
|Antiseptikum
   Arial">-</span>
|Natriumhypo-chlorid Spüllösung
| style="width:2.0cm;" width="76" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">Gefahr von Pilzinfektionen bei längerer Anwendung</span>
1% oder 3%
|- style="height:4.9ptpx;"
|5 - 7 d
| style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
|  -
  Arial">zusätzlich</span>
|   -
| style="width:77.95pt;" width="104" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">Antiseptikum</span>
| style="width:3.0cm;" width="113" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">Natriumhypo-chlorid Spüllösung</span>
 
<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">1% oder 3%</span>
| style="width:42.5pt;" width="57" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">5-7d</span>
| style="width:2.0cm;" width="76" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
   Arial">-</span>
| style="width:2.0cm;" width="76" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">-</span>
|}
|}


====<span style="font-family:&quot;Arial&quot;,sans-serif">Operativer Pfad</span>====
====== <span style="font-family:&quot;Arial&quot;,sans-serif">Operativer Pfad</span> ======


*<span style="font-family:&quot;Arial&quot;,sans-serif">Tympanoplastik (im infektfreien Intervall)</span>
*<span style="font-family:&quot;Arial&quot;,sans-serif">Tympanoplastik (im infektfreien Intervall)</span>
Line 60: Line 48:




===Otitis media chronica epitympanalis===
==== Otitis media chronica epitympanalis ====
<span style="font-size:12.0pt;line-height:107%;font-family:
<span style="font-size:12.0pt;line-height:107%;font-family:
&quot;Arial&quot;,sans-serif">Bei der Otitis media chronica epitympanalis besteht die Indikation zur chirurgischen Versorgung, da es zu Komplikationen wir Hörverlust kommen kann.</span>
&quot;Arial&quot;,sans-serif">Bei der Otitis media chronica epitympanalis besteht die Indikation zur chirurgischen Versorgung, da es zu Komplikationen wie Hörverlust kommen kann.</span>
   
   
{| class="wikitable sortable mw-collapsible filterable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="605" style="margin-left:-.25pt;border-collapse:collapse;mso-table-layout-alt:fixed;"
{| class="wikitable  
|+
|+
| style="width:70.9pt;" width="95" valign="top" |'''<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">Klinische Situation</span>'''
!Klinische Situation
| style="width:63.8pt;" width="85" valign="top" |'''<span style="color: black">Präferenz</span>'''
!Präferenz
| style="width:77.95pt;" width="104" valign="top" |'''<span style="color: black">Substanz</span>'''
!Substanz
| style="width:3.0cm;" width="113" valign="top" |'''<span style="color: black">Dosierung</span>'''
!Dosierung
| style="width:49.6pt;" width="66" valign="top" |'''<span style="color: black">Dauer</span>'''
!Dauer
| style="width:2.0cm;" width="76" valign="top" |'''<span style="color: black">Anpassungen</span>'''
!Anpassungen
| style="width:49.6pt;" width="66" valign="top" |'''<span style="color: black">Kommentar</span>'''
!Kommentar
|- style="height:27.7ptpx;"
|-
| rowspan="2" style="width:70.9pt;" width="95" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
| rowspan="2" |  
  Arial">Otitis</span> media <span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">chronica</span><span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial;
Otitis media chronica
   mso-ansi-language:NO-BOK"> </span>
epi- und mesotympanalis
|Therapie der Wahl
|Lokaltherapie mit Ciprofloxacin Ohrtropfen
|2 x 3-4 Gtt.
|5 - 7 d
|  -
|Gefahr von Pilzinfektionen bei längerer Anwendung
|-
|zusätzlich
|Antiseptikum
|Natriumhypo-chlorid Spüllösung
1% oder 3%
|5 - 7 d
|  -
|   -
|}


<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">epi- und  mesotympanalis</span>
| style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">Therapie der Wahl</span>
| style="width:77.95pt;" width="104" valign="top" |<span style="font-size:11.0pt">Lokaltherapie mit Ciprofloxacin Ohrtropfen</span>
| style="width:3.0cm;" width="113" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">2 x 3-4 Gtt.</span>
| style="width:49.6pt;" width="66" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">5-7d</span>
| style="width:2.0cm;" width="76" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">-</span>
| style="width:49.6pt;" width="66" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">Gefahr  von Pilzinfektionen bei längerer Anwendung</span>
|- style="height:4.9ptpx;"
| style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">zusätzlich</span>
| style="width:77.95pt;" width="104" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">Antiseptikum</span>
| style="width:3.0cm;" width="113" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">Natriumhypo-chlorid Spüllösung</span>


<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">1% oder  3%</span>
| style="width:49.6pt;" width="66" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">5-7d</span>
| style="width:2.0cm;" width="76" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">-</span>
| style="width:49.6pt;" width="66" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">-</span>
|}
<span style="font-size:12.0pt;line-height:107%;font-family:
<span style="font-size:12.0pt;line-height:107%;font-family:
&quot;Arial&quot;,sans-serif">Im Falle eine Exazerbation ist eine antibiotische Therapie indiziert.</span>
&quot;Arial&quot;,sans-serif">Im Falle eine Exazerbation ist eine antibiotische Therapie indiziert.</span>
   
   
{| class="wikitable sortable mw-collapsible filterable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="605" style="margin-left:-.25pt;border-collapse:collapse;mso-table-layout-alt:fixed;"
{| class="wikitable  
|+
|+
| style="width:70.9pt;" width="95" valign="top" |'''<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">Klinische  Situation</span>'''
!Klinische Situation
| style="width:63.8pt;" width="85" valign="top" |'''<span style="color: black">Präferenz</span>'''
!Präferenz
| style="width:77.95pt;" width="104" valign="top" |'''<span style="color: black">Substanz</span>'''
!Substanz
| style="width:3.0cm;" width="113" valign="top" |'''<span style="color: black">Dosierung</span>'''
!Dosierung
| style="width:49.6pt;" width="66" valign="top" |'''<span style="color: black">Dauer</span>'''
!Dauer
| style="width:2.0cm;" width="76" valign="top" |'''<span style="color: black">Anpassungen</span>'''
!Anpassungen
| style="width:49.6pt;" width="66" valign="top" |'''<span style="color: black">Kommentar</span>'''
!Kommentar
|- style="height:27.7ptpx;"
|-
| rowspan="2" style="width:70.9pt;" width="95" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
| rowspan="2" |  
  Arial">Otitis media chronica</span>
Otitis media chronica
epi- und mesotympanalis
|Therapie der Wahl
|Piperacillin/  
Tazobactam
|3 x 4,5 g i.v.
|5 - 7 d
|   -
|   -
|-
|Alternativ
|Ciprofloxacin
|2  x 500 mg p.o.
|5 - 7 d
|   -
|   -
|}
 
S2K-Leitline „Chronische mesotympanale Otitis media (CMOM), AWMF-Register-Nr. 017/074, Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde. Kopf- und Hals-Chirurgie e.V.
 
1. Kemppainen HO, Puhakka HJ, Laippala PJ, Sipilä MM, Manninen MP, Karma PH. Epidemiology and aetiology of middle ear cholesteatoma. Acta Otolaryngol. 1999;119(5):568-572. doi:10.1080/00016489950180801


<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">epi- und</span> mesotympanalis
2. Monasta L, Ronfani L, Marchetti F, et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One. 2012;7(4):e36226. doi:10.1371/journal.pone.0036226
| style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">Therapie der Wahl</span>
| style="width:77.95pt;" width="104" valign="top" |<span style="font-size:11.0pt">Piperacillin/</span>


<span style="font-size:11.0pt">Sulbactam</span>
3. 017-074l_S2k_Chronisch-mesotympanale-Otitis-media_2020-11_01.pdf. Accessed July 9, 2021. https://www.awmf.org/uploads/tx_szleitlinien/017-074l_S2k_Chronisch-mesotympanale-Otitis-media_2020-11_01.pdf
| style="width:3.0cm;" width="113" valign="top" |<span style="font-size:12.0pt;font-family:&quot;Arial&quot;,sans-serif;
  mso-fareast-font-family:Arial">3 x 4,5 g q8h i.v.</span>
| style="width:49.6pt;" width="66" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">5-7 d</span>
| style="width:2.0cm;" width="76" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">-</span>
| style="width:49.6pt;" width="66" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">-</span>
|- style="height:4.9ptpx;"
| style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">Alternativ</span>
| style="width:77.95pt;" width="104" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">Ciprofloxacin</span>
| style="width:3.0cm;" width="113" valign="top" |<span style="font-size:12.0pt;font-family:&quot;Arial&quot;,sans-serif;
  mso-fareast-font-family:Arial">2 * 500 mg p.o./i.v.</span>
| style="width:49.6pt;" width="66" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">5-7d</span>
| style="width:2.0cm;" width="76" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
  Arial">-</span>
| style="width:49.6pt;" width="66" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">-</span>
|}

Latest revision as of 13:07, 9 July 2021

Therapie

Otitis media chronica mesotympanalis

Bei der Therapie können grundsätzlich zwei Wege eingeschlagen werden.

Konservativer Pfad
  • Im infektfreien Intervall sollte ein Wassereintritt in das betroffene Ohr unbedingt vermieden werden
  • Regelmäßige Gehörgangs Reinigung
  • Bei fehlender OP-Indikation Versorgung mit einem Hörgerät
  • Im akuten, sezernierenden Stadium


Klinische Situation Präferenz Substanz Dosierung Dauer Anpassungen Kommentar

Otitis media chronica mesotympanalis

Therapie der Wahl Lokaltherapie mit Ciprofloxacin Ohrtropfen 2 x 3-4 Gtt. 5 - 7 d - Gefahr von Pilzinfektionen bei längerer Anwendung
zusätzlich Antiseptikum Natriumhypo-chlorid Spüllösung

1% oder 3%

5 - 7 d - -
Operativer Pfad
  • Tympanoplastik (im infektfreien Intervall)
  • Bei Kindern Adenotomie zur besseren Mittelohrbelüftung
  • Bei Erwachsenen Conchotomie, Nasenseptumplastik


Otitis media chronica epitympanalis

Bei der Otitis media chronica epitympanalis besteht die Indikation zur chirurgischen Versorgung, da es zu Komplikationen wie Hörverlust kommen kann.

Klinische Situation Präferenz Substanz Dosierung Dauer Anpassungen Kommentar

Otitis media chronica epi- und mesotympanalis

Therapie der Wahl Lokaltherapie mit Ciprofloxacin Ohrtropfen 2 x 3-4 Gtt. 5 - 7 d - Gefahr von Pilzinfektionen bei längerer Anwendung
zusätzlich Antiseptikum Natriumhypo-chlorid Spüllösung

1% oder 3%

5 - 7 d - -


Im Falle eine Exazerbation ist eine antibiotische Therapie indiziert.

Klinische Situation Präferenz Substanz Dosierung Dauer Anpassungen Kommentar

Otitis media chronica epi- und mesotympanalis

Therapie der Wahl Piperacillin/

Tazobactam

3 x 4,5 g i.v. 5 - 7 d - -
Alternativ Ciprofloxacin 2 x 500 mg p.o. 5 - 7 d - -

S2K-Leitline „Chronische mesotympanale Otitis media (CMOM), AWMF-Register-Nr. 017/074, Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde. Kopf- und Hals-Chirurgie e.V.

1. Kemppainen HO, Puhakka HJ, Laippala PJ, Sipilä MM, Manninen MP, Karma PH. Epidemiology and aetiology of middle ear cholesteatoma. Acta Otolaryngol. 1999;119(5):568-572. doi:10.1080/00016489950180801

2. Monasta L, Ronfani L, Marchetti F, et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One. 2012;7(4):e36226. doi:10.1371/journal.pone.0036226

3. 017-074l_S2k_Chronisch-mesotympanale-Otitis-media_2020-11_01.pdf. Accessed July 9, 2021. https://www.awmf.org/uploads/tx_szleitlinien/017-074l_S2k_Chronisch-mesotympanale-Otitis-media_2020-11_01.pdf

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