「case 77 (Otitis Media)」の編集履歴（バックアップ）一覧はこちら

「case 77 (Otitis Media)」(2007/01/23 (火) 18:49:41) の最新版変更点

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削除された行は赤色になります。

<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
<font size="3">急性中耳炎</font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
概念</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
上気道感染に引き続き</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳管を経由による中耳の感染症</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
症状</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発熱</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼻漏</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳痛</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳漏</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
乳幼児では耳痛を訴えず</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
機嫌が悪い</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳に手をやる</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発熱などの症状があるときに本症を疑うことが大切</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
疫学</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face="Century">:
2</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">歳以下に好発</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">, 3</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">歳までに</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">70%</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">が罹患</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
反復例・重症例が増加している</span> <span style=
"FONT-SIZE: 10pt"><font face="Century"><span lang=
"EN-US">(</span></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">保育園に通っている児に多い</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">)<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
起炎菌</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
肺炎球菌とインフルエンザ菌</span> <span style=
"FONT-SIZE: 10pt"><font face="Century"><span lang=
"EN-US">(</span></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">両方ともペニシリン耐性菌が多い</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
で</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">80%</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">を占め</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
他には</span><font face="Century"><i style=
"mso-bidi-font-style: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt">Moraxella catarrhalis</span></i><span lang="EN-US" style=
"FONT-SIZE: 10pt">,</span></font> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
黄色ブドウ球菌</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
エピソードごとに菌を同定すべき</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼓膜所見</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
早期にはツチ骨柄にそって血管拡張</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
炎症が高度になると鼓膜充血・肥厚</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ツチ骨柄不明</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
治療</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼓膜切開</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
抗菌薬</span> <span style="FONT-SIZE: 10pt"><font face="Century"><span lang=
"EN-US">(</span></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">ペニシリン系</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
セフェム系が第一選択</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">),</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼻咽腔の処置</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼓膜換気チューブ</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
合併症</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
急性乳様突起炎</span> <span style="FONT-SIZE: 10pt"><font face=
"Century"><span lang="EN-US">(</span></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">耳の後ろが腫れる</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳が立つ</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
炎症が高度で他の合併症がある場合は削開術による排膿</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">),</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
脳膿瘍</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
髄膜炎</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
伝音</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">/</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">感音難聴</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
めまい</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
顔面神経麻痺</span> <span style="FONT-SIZE: 10pt"><font face=
"Century"><span lang="EN-US">(</span></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">泣いたときに目・口・鼻が非対称</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">),</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
など</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang=
"EN-US"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
参考</span><span lang="EN-US" style="FONT-SIZE: 8pt"><br></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
浸出性中耳炎</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><br></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
概念</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼓膜に線香がなく中耳に貯留液があるが</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳痛や発熱といった急性感染症状のない中耳炎</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
病因</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳管機能不全が関係</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
アデノイド</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
口蓋裂</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
上咽頭腫瘍</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼻すすり</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
疫学</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face="Century">:
4-8</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">歳に多く</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">, 10</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">歳以降は少ない</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
高齢者にもピークがある</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
急性中耳炎罹患児の約</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">1/3</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">は滲出性中耳炎になる</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
症状</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
成人では耳閉塞感</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
難聴</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳鳴</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
自声強調</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
小児では自覚症状</span> <span style="FONT-SIZE: 8pt"><font face=
"Century"><span lang="EN-US">(</span></font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">訴え</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
がなく</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
テレビの音量を大きくする</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
読んでも返事をしない</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
幼稚園・保育園での反応の異常に教師が気付くなど</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
難聴が悪化して言語発達に影響が生じることもある</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
参考文献</span><span lang="EN-US" style="FONT-SIZE: 10pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
講義ノート</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
喜多村</span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
健</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face="Century">:
NEW</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">耳鼻咽喉科・頭頚部外科學</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
南江堂</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">, 1999<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
シナリオにおける注釈</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face="Century">History of
Present Illness<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 15pt; mso-char-indent-count: 1.5">
<span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">sulfisoxazole:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
サルファ剤系抗菌薬のひとつ</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
日本では点眼のみ</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">QUESTIONS<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">2.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
鼻漏</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
不機嫌</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
発熱</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
耳を引っ張る</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">3.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
米国において小児発熱にアスピリンは禁</span><span lang="EN-US"
style="FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face="Century">4.
Cefpodoxime proxetil</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
は経口セフェムで</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">

<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
<font size="3">急性中耳炎</font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
概念</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
上気道感染に引き続き</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳管を経由による中耳の感染症</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
症状</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発熱</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼻漏</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳痛</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳漏</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
乳幼児では耳痛を訴えず</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
機嫌が悪い</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳に手をやる</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発熱などの症状があるときに本症を疑うことが大切</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
疫学</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:2</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">歳以下に好発</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">, 3</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">歳までに</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">70%</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">が罹患</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
反復例・重症例が増加している</span> <span style=
"FONT-SIZE: 10pt"><font face="Century"><span lang=
"EN-US">(</span></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">保育園に通っている児に多い</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">)<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
起炎菌</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
肺炎球菌とインフルエンザ菌</span> <span style=
"FONT-SIZE: 10pt"><font face="Century"><span lang=
"EN-US">(</span></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">両方ともペニシリン耐性菌が多い</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
で</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">80%</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">を占め</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
他には</span><font face="Century"><i style=
"mso-bidi-font-style: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt">Moraxella catarrhalis</span></i><span lang="EN-US" style=
"FONT-SIZE: 10pt">,</span></font> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
黄色ブドウ球菌</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
エピソードごとに菌を同定すべき</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼓膜所見</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
早期にはツチ骨柄にそって血管拡張</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
炎症が高度になると鼓膜充血・肥厚</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ツチ骨柄不明</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
治療</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼓膜切開</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
抗菌薬</span> <span style="FONT-SIZE: 10pt"><font face="Century"><span lang=
"EN-US">(</span></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">ペニシリン系</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
セフェム系が第一選択</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">),</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼻咽腔の処置</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼓膜換気チューブ</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 25pt; TEXT-INDENT: -25pt; mso-char-indent-count: -2.5">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
合併症</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
急性乳様突起炎</span> <span style="FONT-SIZE: 10pt"><font face=
"Century"><span lang="EN-US">(</span></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">耳の後ろが腫れる</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳が立つ</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
炎症が高度で他の合併症がある場合は削開術による排膿</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">),</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
脳膿瘍</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
髄膜炎</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
伝音</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">/</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">感音難聴</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
めまい</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
顔面神経麻痺</span> <span style="FONT-SIZE: 10pt"><font face=
"Century"><span lang="EN-US">(</span></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">泣いたときに目・口・鼻が非対称</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">),</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
など</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang=
"EN-US"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
参考</span><span lang="EN-US" style="FONT-SIZE: 8pt"><br></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
浸出性中耳炎</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><br></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
概念</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼓膜に線香がなく中耳に貯留液があるが</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳痛や発熱といった急性感染症状のない中耳炎</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
病因</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳管機能不全が関係</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
アデノイド</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
口蓋裂</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
上咽頭腫瘍</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼻すすり</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
疫学</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">:4-8</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">歳に多く</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">, 10</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">歳以降は少ない</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
高齢者にもピークがある</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
急性中耳炎罹患児の約</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">1/3</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">は滲出性中耳炎になる</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 12pt; TEXT-INDENT: -12pt; mso-char-indent-count: -1.5">
<span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
症状</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
成人では耳閉塞感</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
難聴</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳鳴</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
自声強調</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
小児では自覚症状</span> <span style="FONT-SIZE: 8pt"><font face=
"Century"><span lang="EN-US">(</span></font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">訴え</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
がなく</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
テレビの音量を大きくする</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
読んでも返事をしない</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
幼稚園・保育園での反応の異常に教師が気付くなど</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
難聴が悪化して言語発達に影響が生じることもある</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
参考文献</span><span lang="EN-US" style="FONT-SIZE: 10pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
講義ノート</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
喜多村</span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
健</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:NEW</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">耳鼻咽喉科・頭頚部外科學</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
南江堂</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">, 1999<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
シナリオにおける注釈</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face="Century">History
ofPresent Illness<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 15pt; mso-char-indent-count: 1.5">
<span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">sulfisoxazole:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
サルファ剤系抗菌薬のひとつ</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
日本では点眼のみ</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">QUESTIONS<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">2.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
鼻漏</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
不機嫌</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
発熱</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
耳を引っ張る</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">3.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
米国において小児発熱にアスピリンは禁</span><span lang="EN-US"
style="FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">4.Cefpodoxime proxetil</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
は経口セフェムで</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">�</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">ラクタマーゼに安定</span><span lang="EN-US"
style="FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">5.(1)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
ペニシリンアレルギー</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face="Century">,
(2)3</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">日間投与で無効</span><span lang="EN-US"
style="FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,(3)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
最近の</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">2</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">例で無効</span><span lang="EN-US"
style="FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,(4)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
培養で耐性</span> <span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">(+),(5)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
合併症あり</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">7.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
うつぶせ寝</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
耳管の長さと機能</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face="Century">9.clavulanic
acid: �</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">ラクタマーゼ阻害作用あり</span><span lang="EN-US"
style="FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">10.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 8pt; mso-bidi-font-weight: bold"><font face=
"Century">Phenylephrine(Nasal):<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 8pt; mso-bidi-font-weight: bold"><font face="Century">[<i style=
"mso-bidi-font-style: normal">Medline Plus</i>]</font></span> <span lang=
"EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">Phenylephrine(fen-ill-EF-rin) is used for the temporary relief of
congestion or stuffinessin the nose caused by hay fever or other allergies,
colds, or sinus trouble. Itmay also be used in ear infections to relieve
congestion.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">This medicine may also be used for
otherconditions as determined by your doctor.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">This medicine is available without
aprescription; however, your doctor may have special instructions on the
properuse or dose for your medical condition.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face=
"Century"><span lang="EN-US" style="FONT-SIZE: 8pt">Phenylephrine is
availablein the following dosage forms: <i>Nasal</i> Nasal jelly
(</span><span lang="EN-US" style="FONT-SIZE: 8pt">U.S.</span> <span lang=
"EN-US" style="FONT-SIZE: 8pt">) / Nasal drops (</span><span lang="EN-US"
style="FONT-SIZE: 8pt">U.S.</span> <span lang="EN-US" style=
"FONT-SIZE: 8pt">and</span> <span lang="EN-US" style=
"FONT-SIZE: 8pt">Canada</span> <span lang="EN-US" style="FONT-SIZE: 8pt">)
/Nasal spray (</span><span lang="EN-US" style=
"FONT-SIZE: 8pt">U.S.</span><span lang="EN-US" style=
"FONT-SIZE: 8pt">and</span> <span lang="EN-US" style=
"FONT-SIZE: 8pt">Canada</span> <span lang="EN-US" style=
"FONT-SIZE: 8pt">)<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
テトラヒゾロリン</span> <span style="FONT-SIZE: 8pt"><font face=
"Century"><span lang="EN-US">(</span></font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">ナーベル</span><font face="Century"><sup><span lang="EN-US"
style="FONT-SIZE: 8pt">�</span></sup><span lang="EN-US" style=
"FONT-SIZE: 8pt">):<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">[<i style=
"mso-bidi-font-style: normal">JAPIC</i>]</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
連用又は頻回使用により反応性の低下や局所粘膜の二次充血を起こすことがあるので，急性充血期に限って使用するか又は適切な休薬期間をおいて使用する</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">12.(1)第</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">一選択の薬剤を適切に使用</span><span lang="EN-US"
style="FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,(2)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
局所薬は無効</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,(3)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
繰り返し来院や過剰診療を避ける</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">13.(1)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
慢性化や合併症を防ぐ</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,(2)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
抗菌薬は</span> <span style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face="Century"><span lang=
"EN-US">(i) 2</span></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">歳以下</span><span lang="EN-US"
style="FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
または</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,(ii)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
慢性・再発性の症例に限る</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,(3)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
抗ヒスタミン薬</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
充血除去薬は無効</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
むしろ副作用のリスクが大きい</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">,(4)</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century; mso-bidi-font-weight: bold">
保護者の教育も大切</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-bidi-font-weight: bold"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>