成人分泌性中耳炎的感染因素

对８６例成人分泌性中耳炎患者的中耳积液行涂片检查，细菌培养和鲎血试验，结果表明，分泌性中耳炎中耳腔中细菌和内毒素的存在是中耳积液发生或使积液迁延不愈的重要原因之一；内毒素检出率高于细菌分离率与与抗生素的使用密切相关、提示用抗生素治疗分泌性中耳炎对中耳积液的消退有积极意义。     

呼吸道病毒中耳感染与分泌性中耳炎发病的相关性研究

目的：探讨呼吸道病毒中耳感染与分泌性中耳炎发病的相关关系。方法：利用碱性磷酸酶抗碱性磷酸酶（alkaline phosphatase anti-alkaline phosphatase,APAAP)桥联酶标技术，检测分泌性中耳炎患者中耳积液所含脱落上皮细胞中的六种常见的呼吸道病毒抗原。结果：88例中耳积液中有65例（73．9％）检测到一种以上呼吸道病毒抗原，其中三例可同时检测到六种病毒抗原。发病前感冒史与抗原阳性率有明显相关性。结论：分泌性中耳炎患者中耳腔有多重病毒感染的可能，该病的发生与急性呼吸道感染有明显的关系。     

耳科学

成人分泌性中耳炎与胃食管反流的相关性研究目的:为了探讨成人分泌性中耳炎(OME)与胃食管反流(GER)的临床相关性。方法:对60名OME患者(排除了航空变压和急性中耳炎导致的中耳积液)进行针对GER诊断的问卷调查,并采用化学发光酶免疫测定法测定其中耳积液中的胃蛋白酶(PG)的含量。结果:其中GER诊断阴性者46例,仅2例     

声反射在成人分泌性中耳炎中的诊断价值

目的提高耳科门诊成人分泌性中耳炎中耳积液的检出率,探讨声反射在协助诊断分泌性中耳炎是否伴有中耳积液中的临床价值。方法回顾性分析耳鼻咽喉科门诊169例确诊为分泌性中耳炎伴有中耳积液的成年患者的临床资料,并对听力正常与听力下降患者的鼓室图、同侧声反射及纯音测听等资料进行对比。结果169例(237耳)经鼓膜穿刺证实为中耳积液的患者中,223耳(94.1%)未引出声反射,14耳(5.9%)引出声反射;鼓室图异常200耳(84.4%),正常者37耳(15.6%);216耳(91.1%)有传导性听力下降,21耳(8.9%)听力正常。不论听力是否下降,同侧声反射的未引出率均高于异常鼓室图的概率(P<0.05);在不同听力及不同类型鼓室图中,声反射的未引出率没有差异(P>0.05),具有无创、快捷及客观等优点,能更好的帮助临床工作者评估分泌性中耳炎的疗效及预后。结论声反射能协助提高成人分泌性中耳炎伴中耳积液的检出率,具有无创、快速及客观等优点,能更好地帮助临床工作者评估分泌性中耳炎的疗效及预后。     

中耳积液中纤维蛋白原含量与分泌性中耳炎疗效的关系

目的探讨中耳积液中纤维蛋白原含量与分泌性中耳炎病情迁延的关系及巴曲酶治疗分泌性中耳炎的可能机制。方法用凝固法对156例分泌性中耳炎患者治疗过程中的中耳积液中纤维蛋白原含量进行动态检测。鼓室抽液2次（间隔1周），积液复发者随机分成巴曲酶组及地塞米松组，穿刺后分别用0．5ml巴曲酶（2BU／ml）或0．5ml地塞米松（2mg／ml）行鼓室内注射治疗，观察治疗效果。结果积液复发组第1、2次复发中耳积液中纤维蛋白原含量均明显高于痊愈组，且第2次复发者的中耳积液纤维蛋白原含量更高（P〈0．01）。巴曲酶组治疗有效率为91．6％，较地塞米松组（有效率为62．5％）差异有统计学意义（P〈0．001）。治疗后6个月巴曲酶组平均气导听阈值（0．5、1．0、2．0kHz）变化与地塞米松组比较，治疗1周后2组中耳积液中纤维蛋白原含量差异，均有统计学意义（P〈0．01）。结论纤维蛋白原可能在分泌性中耳炎发生发展中起重要作用；鼓室内注射巴曲酶比注射地塞米松治疗分泌性中耳炎，疗效差异有统计学意义，其机制可能是通过降解纤维蛋白原以解除其对咽鼓管表面活性物质的抑制作用或（和）阻止其转变成不溶性纤维蛋白聚合体。     

儿童与成人慢性分泌性中耳炎细菌学特点的分析

目的对比研究中耳炎差异球菌、肺炎链球菌、流感嗜血杆菌、卡他莫拉菌、金黄色葡萄球菌、草绿色链球菌在慢性分泌性中耳炎(secretory otitis media,SOM)儿童及成人患者的中耳积液(middle ear fluid,MEF)及鼻咽部分泌物(nasopharynx,Nph)中的检出率。方法运用PCR技术，观察并比较6种细菌在慢性分泌物中耳炎儿童组与成人组患者的MEF及Nph中的阳性率。结果①本研究中SOM儿童组与成人组患者MEF的主要细菌分布相似。PCR检测阳性率分别为91.30%（63/69）和 88.25%（30/34），差异无统计学意义（χ2=0.244，P>0.05）；②儿童组及成人组患者的MEF中，常可检测出2种或2种以上的细菌，但儿童组较成人组更为常见，差异具有统计学意义（P<0.05）；③儿童组患者MEF中阳性率最高的细菌为肺炎链球菌及金黄色葡萄球菌，成人组患者MEF中阳性率最高的细菌为金黄色葡萄球菌；④儿童组患者的MEF中，肺炎链球菌的阳性率高于成人组，差异具有统计学意义（χ2=5.526，P<0.05），其余5种细菌差异无统计学意义（P>0.05）；⑤儿童组MEF与Nph细菌阳性率比较，NPh中草绿色链球菌、流感嗜血杆菌、卡他莫拉菌的阳性率均高于MEF（χ2=21.852，P<0.05；χ2=21.369，P<0.05；χ2=4.309，P<0.05），差异具有统计学意义（P<0.05）；而金黄色葡萄球菌、肺炎链球菌及耳炎差异球菌在MEF与Nph中阳性率相似，差异均无统计学意义（P>0.05）；⑥成人组MEF与Nph细菌检出率比较，除草绿色链球菌在Nph中阳性率高于MEF（χ2=15.281，P<0.05）外，其余5种细菌差异均无统计学意义（P>0.05）。结论SOM儿童患者较成人更易发生中耳腔多种细菌混合性感染。     

IL-1β和IL-8在分泌性中耳炎中耳积液中的表达及意义

目的探讨IL-1β和IL-8在分泌性中耳炎发生和转归中的作用。方法应用酶联免疫吸附法(ELISA)检测38例分泌性中耳炎患者40耳中耳积液中IL-1β和IL-8的含量。结果IL-1β和IL-8在分泌性中耳炎中耳积液中的表达率分别为80%和92.5%,早期积液中IL-1β和IL-8的含量高于晚期(P均<0.001),浆液性积液中二者的含量亦较高(P<0.002,P<0.05),IL-8与IL-1β的含量呈正相关(r=0.83,р<0.01)。结论IL-1β和IL-8是分泌性中耳炎中耳积液形成众多细胞因子中的两种,均存在于早期中耳积液中,并促进浆液性中耳积液的产生,前者对后者的产生有促进作用。     

分泌性中耳炎中耳积液的内毒素含量测定及其意义

测定34例分泌性中耳炎患者中耳积液与皿浆内毒素含量,并以22例正常人血浆内毒素含量作对照。结果为:患者中耳积液内毒素均值(X±SE)为629.4±99.1ng/L,是血浆内毒素(46.4±6.7ng/L)的13.6倍,p<0.01;94％的患者中耳积液内毒素值超过正常人血浆内毒素含量上限。表明分泌性中耳炎中耳积液定量测定,较之定性测定和细菌培养,更具敏感、精确、简便、快速等优点,对估计预后和临床用药有指导意义。     

儿童分泌性中耳炎中耳积液病毒和支原体及衣原体检测结果分析

目的　探讨儿童分泌性中耳炎中耳积液中常见病毒、支原体和衣原体存在情况。方法　选取我院住院手术治疗的150例分泌性中耳炎患儿，对中耳积液行13种常见呼吸道病毒、支原体和衣原体聚合酶链反应检测。结果  中耳积液检测阳性率28.0%。其中鼻病毒阳性率23.3%，显著高于其他病原体阳性率4.7%（χ2=21.705，P =0.000）。学 龄前患儿中耳积液检测阳性率33.7%，显著高于学龄期患儿阳性率16.3%（χ2=4.919，P =0.027），急性-亚急性分泌性中耳炎检测阳性率41.1%，显著高于慢性分泌性中耳炎20.2%（χ2=7.574，P =0.006）。结论　儿童分泌性中耳炎中耳积液感染主要为鼻病毒，学龄前患儿及分泌性中耳炎急性-亚急性期感染更为常见。     

分泌性中耳炎中耳积液中γ干扰素测定的临床意义

目的:探讨分泌性中耳炎(SOM)患者的中耳积液中IFNγ浓度测定的临床意义。方法:用双抗夹心酶联免疫吸附法检测51例(56耳)SOM患者(中耳炎组)的中耳积液、血清及24例正常成人(对照组)血清中IFNγ的浓度。结果:中耳炎组积液中IFNγ的浓度明显高于其血清中的浓度(P<0.01);中耳炎组与对照组血清中的浓度差异无统计学意义(P>0.05);SOM慢性期IFNγ浓度明显高于急性期(P<0.05);首次穿刺及第2次穿刺积液中IFNγ的浓度差异无统计学意义(P>0.05);而第3次或3次以上穿刺积液中IFNγ的浓度则明显升高(P<0.01)。结论:中耳积液中的IFNγ可由中耳腔局部产生,而非单纯由血液中渗透而来;中耳积液中IFNγ的高浓度可作为SOM转为慢性病程或迁延不愈的参考。     

Alloiococcus otitidis in acute otitis media

OBJECTIVE: The bacterium Alloiococcus otitidis has been found to be associated with otitis media with effusion (OME). When the culture method is used, its detection rate is low, whereas applying the polymerase chain reaction (PCR) yields significantly higher frequencies. This study was carried out to investigate the incidence of A. otitidis in children with acute otitis media (AOM). METHODS: Multiplex PCR was used to detect A. otitidis together with Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae in the middle ear effusions (MEEs) of 118 children with AOM. The clinical outcome of AOM and the bacterial findings of MEEs were compared. RESULTS: A. otitidis was detected in 25% (30 of 118) of the tested MEE samples. Children over 2 years of age had significantly more often A. otitidis-positive MEEs (37%; 22 of 59) than younger children (14%; 8 of 59) (chi-square test, P<0.01). There were no significant differences in the duration, clinical failures (after antibiotic treatment), or number of recurrences of AOM between the A. otitidis-positive and A. otitidis-negative children. CONCLUSIONS: A. otitidis is found from the MEEs of AOM. The present data suggest that it has no clinical significance in AOM, and it does not increase the risk of developing OME after AOM.     

Serous otitis media in children: implication of Alloiococcus otitidis.

OBJECTIVE: Otitis media with effusion (OME) has long been considered to be a noninfective disease resulting from a eustachian tube dysfunction. However, several microbiological techniques have shown bacteria in the middle ear fluids from patients with OME. Alloiococcus otitidis has been detected in the middle ear fluid from patients with OME. The exact role of this infectious agent in the pathogenesis of OME has yet to be elucidated. STUDY DESIGN: A prospective clinical trial. SETTING: A tertiary university-based referral center. PATIENTS: The inclusion criteria included 110 patients aged between 1 and 12 years. The control group included samples obtained from 30 healthy children undergoing a cochlear implantation. The second group included 40 middle ear effusions (MEEs) that were collected from 40 pediatric OME patients during the placement of the ventilation tube. As for the third group, they were 40 children with acute otitis media. Intervention: The bacterial analysis of the MEE was performed by means of microbiological culture-specific techniques. MAIN OUTCOME MEASURE: Positive cultures for A. otitidis as analyzed by bacteriological analysis of samples from the middle ear mucosa and MEE. RESULTS: Bacteria were present in the culture of 72.5% (29) of the patients with OME. Alloiococcus otitidis was the most frequent bacterium in OME (48.27%) as well as Haemophilus influenzae nonserotype B (17.24%). Streptococcus pneumoniae was the most commonly detected pathogen in acute otitis media (37.5%), and then H. influenzae nonserotype B (25%). For most of the OME cases, only A. otitidis bacteria were isolated. CONCLUSION: We observed a high rate of culture positivity for A. otitidis in patients with clinical OME without suppuration. Further studies are needed to confirm whether the association of A. otitidis with OME represents causality. Antibiotic therapy aimed at A. otitidis is complicated by reported resistance, thus emphasizing the importance of our understanding of the pathogenetic role played by this organism     

沙眼衣原体感染与分泌性中耳炎的关系

目的：探讨沙眼衣原体（Ct）感染与分泌性中耳炎（SOM）发病的关系。方法：PCR检测157例（183耳）SOM患者的中耳积液（MEE），用荧光定量PCR（FQ-PCR）对阳性标本进行定量检测，用McCoy细胞对其中含高拷贝数基因的标本进行Ct分离培养。结果：PCR检测的183份MEE标本中，29份为阳性，FQ-PCR检测这些阳性标本基因拷贝数在2．0×10^6／L～6．0×10^10／L，11耳高拷贝数基因的标本分离到1株Ct。结论：Ct感染与SOM发病有关，可能是导致SOM的致病微生物之一。     

Biochemical differences in middle ear effusions between pediatric and adult patients, (II). The protein composition

To clarify the biochemical differences between pediatric and adult middle ear effusions (MEEs) in secretory otitis media with effusion (OME), we analyzed the protein components from MEEs of 3 children and 3 adults by electrophoresis. High molecular protein components (280 and 265 kDa proteins), which contained in sera in the concentrations less than 2.5%, were not detected in MEEs even in trace amounts. The protein components which molecular weights were less than 260 kDa are transferred from sera into MEEs in a same proportion as in sera. Mucin type glycoprotein was comprised about 30% of the total protein in pediatric mucous MEEs and the weight ratio of mucin to albumin in pediatric mucous MEEs was 2.69, but serous MEEs from adult patients did not contain mucin. Immunoglobulin (IgA, IgG and IgM) concentrations in pediatric mucous MEEs were same as in adult serous MEEs. The concentrations of IgA and IgM in MEEs were higher than in sera. Lysozyme concentration in MEEs was also higher than in sera, and that in pediatric mucous MEEs was nearly 2 times higher than serous MEEs from adult patients.     

Characteristic differences in the lipid composition of middle ear effusions in adult and pediatric patients: phosphatidylethanolamine and phosphatidylserine levels

Summary Middle ear effusions (MEEs) from adult patients with otitis media with effusion are usually serous in nature, but those from pediatric patients younger than 8 years old are frequently mucous in consistency. MEEs contain substances secreted by the epithelial cells of the middle ear and eustachian tube to regulate surface tensions as well as those produced as the result of inflammation. Since the biochemical bases of serous and mucous MEEs have not been clearly established, we analyzed all lipid components of MEEs from seven children and seven adults by thin-layer and gas-liquid chromatography, and also compared them with those from sera. Although no significant difference in the lipid composition was observed between adult and pediatric sera, the relative concentration of phosphatidylethanolamine (PE) in the pediatric MEEs was 26.5%, while that in the adult MEEs was 9.2% and was significantly different. A similar high concentration of phosphatidylserine (PS) was also observed in the pediatric MEE. Since phospholipids are major components of surfactants secreted from the epithelial cells of the middle ear, significantly high concentrations of both PE and PS as charged phospholipids may be responsible in part for the mucoid characteristics seen in pediatric MEEs.This work was supported in part by a Grant-in-Aid for Acute Profound Deafness from the Ministry of Health and Welfare, Japan Offprint requests to: R. Yabe     

TH1/TH2 and regulatory cytokines in adults with otitis media with effusion.

OBJECTIVE: Otitis media with effusion is one of the most common and intractable ear diseases. However, the role of Th1, Th2, and immunoregulatory cytokines on the pathogenesis of the disease in adult patients remains to be determined. The aim of this study is to disclose the cytokine expression in middle ear effusions (MEEs) in adults and to compare the profile on the basis of the presence of allergic rhinitis and the type of effusions. STUDY DESIGN: A prospective controlled clinical study. PATIENTS: MEEs were collected from 80 adult subjects. The concentration of interleukin (IL)-2, IL-4, IL-5, IL-10, IL-12, and interferon (IFN)-gamma in MEEs were determined by using enzyme-linked immunosorbent assay. RESULTS: IL-2, IL-4, IL-5, IL-10, IL-12, and IFN-gamma in MEEs were detected in 60 (75.0%), 33 (41.3%), 42 (52.5%), 14 (17.5%), 80 (100%), and 66 (82.5%) samples, respectively. Among these cytokines, only the concentration of IL-4 in the allergic rhinitis-positive group was significantly higher than that in the allergic rhinitis-negative group. On the other hand, IL-2, IL-12, and IFN-gamma were detected, regardless of the presence of allergic rhinitis, and the concentration of these cytokines correlated with each other. The correlation between the concentration of IL-4 and IL-5 was also detected. In addition, both the incidence rate and the concentration of IL-10 in MEEs were significantly higher in the mucoid type compared with those in the serous type effusions. CONCLUSION: Regardless of allergic status, IL-12 may play a critical role in the pathogenesis of otitis media with effusion by affecting the production of IL-2 and IFN-gamma. In addition, IL-4 may have some impact on the immunologic condition in adults with allergic rhinitis. IL-10 potentially affects the viscosity of MEEs.     

Beta 2-microglobulin in otitis media with effusion

beta 2-Microglobulin (beta 2M) is a low-molecular-weight protein present in serum and other fluids during various autoimmune or chronic inflammatory diseases. beta 2-Microglobulin was measured in middle ear effusion (MEE) and serum samples obtained from 36 patients with chronic otitis media with effusion. Using a quantitative competitive enzyme immunoassay, we were able to demonstrate beta 2M in 98% of the MEE samples. The mean concentration of beta 2M was higher in the MEE samples than in the serum samples. There was considerable variability between ears in those patients with bilateral MEE. There was no correlation between beta 2M concentration and the patients' age, sex, MEE type, and culture results, or cytologic profiles of the MEEs. This increased beta 2M may reflect earlier lymphocyte activity during the inflammatory process.     

Substance P and vasoactive intestinal peptide levels in middle ear effusions of children

Abstract Conclusion: This is the first report demonstrating high levels of substance P (SP) that inversely correlate with vasoactive intestinal peptide (VIP) levels in middle ear effusions (MEEs) of patients with otitis media with effusion (OME). Increased SP and decreased VIP levels might play a role in the pathogenesis of chronic OME. Objective: The etiology of OME is multifactorial, and neurogenic inflammation may play a significant role. SP and VIP levels were not evaluated previously in MEEs of children with OME. Methods: Fifty patients aged 2-12 years (mean age 5.24 ± 2.64) were included in the study. MEEs were classified as mucoid or serous based on the gross appearance. SP and VIP levels were determined using ELISA. Results: High levels of SP were detected in MEEs. In addition SP levels were significantly higher in serous samples (2910.55 ± 307.96 vs 2218.55 ± 262.30 pg/ml). There were also age-dependent changes, such that SP levels were significantly higher in children aged 2-3 years compared with those who were 4-5 and 6-12 years old. VIP levels were undetectable in 30% of patients and the mean level of VIP was 50.91 ± 16.01 pg/ml in serous middle ear effusions and 54.86 ± 15.91 pg/ml in mucoid MEEs.     

Gel chromatographic characterization of proteins in mucous and serous middle ear effusions of patients with otitis media in comparison to serum proteins

Otitis media with effusion (OME) is an inflammatory disease of the middle ear cavity that is associated with middle ear effusions (MEEs), which are frequently mucous and serous for pediatric and adult patients exhibiting low and high responsiveness to medical treatment, respectively. To assess the pathological outcomes in mucous and serous MEEs, their protein compositions were determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting in comparison with those in the same patients’ sera. A mucin, which is immunochemically identical with nasal mucin, was a characteristic consituent of mucous MEEs (n = 25), being present at the concentration of 59.4 mg/ml and comprising about 60% of the total proteins, but it was not detected in serous MEEs (n = 30) or sera. Serum proteins with molecular weights of less than 260 kDa were detected in serous and mucous MEEs, in which albumin was the major protein. Albumin, IgM and α1-acid glycoprotein, and lysozyme, IgA and IgG in MEEs were present at lower and higher concentrations than in sera, respectively. The ratios of IgA, IgG, IgM and α1-acid glycoprotein to albumin in mucous MEEs were 4-, 3-, 1.4- and 1.0-times higher than those in the respective pediatric sera, and those in serous MEEs were 1.7-, 1.7-, 0.6- and 0.3-times higher than those in adult sera. Also, the concentrations of lysozyme in mucous and serous MEEs were 19 and 3 μg/ml, but those in pediatric and adult sera were negligible. These results indicate that the contents of these proteins, in comparison to albumin, might be useful criteria for assessing the inflammation level in MEEs.