Chronischer Mittelohrerguss

Fazit für die Praxis

• Paukenergüsse mit einer Persistenz < 3 Monaten müssen nicht therapiert werden. Hier ist eine „Watchful-Waiting“-Strategie indiziert. Der Versuch der Autoinsufflation mit einem Ballonsystem ist aber durchaus empfehlenswert.

• Paukenergüsse mit einer Persistenz > 3 Monate sollten operativ behandelt werden: Liegt ein vernarbtes, hyperplastisches Adenoid vor, ist eine Adenotomie empfehlenswert. Eine Parazentese mit Absaugen des Sekrets aus dem Mittelohr sollte immer gleichzeitig durchgeführt werden.

• Die Einlage von Paukenröhrchen wird wegen möglicher Spätfolgen national und international zunehmend zurückhaltend bewertet. Sie sollte nur bei anamnestisch längerdauernden oder rezidivierenden Tubenbelüftungsstörungen durchgeführt werden. Permanente Paukenröhrchen (Stativröhrchen/„T-Tubes“; Abb. [11]) sind nur in problematischen Einzelfällen empfehlenswert.

• Literatur

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