Title: Acute Otorrhea in Children with PE tubes
题目：带有鼓膜管的儿童发生急性耳漏
Author 作者: Jennifer Guyther
翻译：李辉 校对：肖锋

Up to 26% of patients with tympanostomy tubes (PE tubes) can suffer from clinically manifested otorrhea.
高达26%的带有鼓膜管（PE管）的患者可能出现临床明确的耳漏。
This is thought to be the result of acute otitis media that is draining through the tube.
这被认为是急性中耳炎通过这一管子引流的结果。
Previous small studies suggested that antibiotic ear drops are as effective or more effective and with less side effects for its treatment.
之前小规模研究提示抗菌素滴耳液的治疗是有效的，且副作用少。
This study compared treatment with antibiotic/glucocorticoid ear drops (hydrocortisone-bacitracin-colistin) to oral Augmentin (30 mg/kg/TID) to observation for 2 weeks.
这一研究比较了抗生素/糖皮质激素滴耳液（氢化可的松-杆菌肽-粘菌素）与口服沃格门汀（30 mg/kg/TID）治疗2周的效果。
Study population: Children 1-10 years with otorrhea for up to 7 days in the Netherlands
研究人群：新西兰1-10岁的儿童，耳漏长达7天
Exclusion criteria included: T > 38.5 C, antibiotics in previous 2 weeks, PE tubes placed within 2 weeks, previous otorrhea in past 4 weeks, 3 or more episodes of otorrhea in past 6 months
排除标准包括：体温＞38.5℃，两周内使用过抗生素，鼓膜管放置时间少于2周，过去的4周发生过耳漏，过去6月发生耳漏3次或以上。
Patient recruitment: ENT and PMD approached pt with PE tubes and they were told to call if otorrhea developed and a home visit would be arranged
患者收入：耳鼻喉医生和私人医生诊治有鼓膜管的患者，告诉他们当出现耳漏时就呼叫，会安排到家里随诊。
Study type: open-label, pragmatic, randomized control trial
研究类型：非盲法，实用性随机对照试验
Primary outcome: Treatment failure defined as the presence of otorrhea observed otoscopically
主要指标：治疗失败定义为耳镜下观察到耳漏。
Secondary outcome: based on parental diaries of symptoms, resolution and recurrence over 6 months
次要指标：以父母的日志为依据，包括超过6个月内的症状，治愈及复发
Results: After 2 weeks, only 5% of the ear drop group compared to 44% of the oral antibiotic group and 55% of the observation group still had otorrhea. There was not a significant difference between those treated with oral antibiotics and those that were observed.
结果：2周后，滴耳液组只有5%的患者仍有耳漏，与之相比，口服抗生素组为44%，观察组为55%。接受口服抗生素治疗组与观察组没有显著差异。
Otorrhea lasted 4 days in the ear drop group compared to 5 days with oral antibiotics and 12 days with observation (all statistically significant).
滴耳液组耳漏持续4天，口服抗生素组为5天，观察组为12天（均有统计学意义）。
Key differences: The antibiotic dosing and choice of ear drops are based on availability and local organism susceptibility.
关键区别：抗生素的剂量及滴耳液的选择依据于当地的可获取性及微生物敏感性。
Bottom line: For otorrhea in the presence of PE tubes, ear drops (with a non-aminoglycoside antibiotic and a steroid) may be more beneficial than oral antibiotics or observation.
要点：对于有鼓膜管的耳漏，滴耳液（非氨基糖苷类抗生素联合激素）效果可能更优于口服抗生素和保守观察。

References 参考文献
van Dongen TM, van der Heijden GJ, Venekamp RP, Rovers MM, Schilder AG. A trial of treatment for acute otorrhea in children with tympanostomy tubes. N Engl J Med 2014; 370:723-733
http://www.ncbi.nlm.nih.gov/pubmed/24552319