MUC蛋白在分泌性中耳炎积液形成中的作用

目的：建立细菌及其产生的内毒素诱导大鼠分泌性中耳炎模型,并探讨中耳黏膜中分泌型黏蛋白的表达,及其对中耳积液产生和发展造成的影响。方法：20只SD健康大鼠随机分为对照组（10只）和实验组（10只）;实验组建立灭活的流感嗜血杆菌引起的分泌性中耳炎模型,在不同时间段以鲎实验法检测中耳积液中的内毒素,ELISA法检测中耳积液中的黏蛋白。对取材黏膜常规染色和AP-PAS染色,观察黏液腺、杯状细胞。结果：实验组中鼓室上皮黏膜内毒素含量平均值是对照组鼓室上皮黏膜中含量的2.1倍,其平均值差异有显著性（P〈0.05）。ELISA法检测中耳积液中的黏蛋白,实验组鼓室上皮黏膜中平均值是对照组中平均值的4.2倍,其平均值差异有显著性（P〈0.05）。结论：细菌的分解产物—内毒素,导致中耳黏膜的炎症反应及中耳腔渗出,引起杯状细胞分泌黏蛋白,从而导致产生中耳积液,甚至胶耳。     

慢性化脓性中耳乳突炎螺旋CT诊断价值

目的探讨慢性化脓性中耳乳突炎螺旋CT检查的诊断价值。方法对手术及病理证实的48例65耳慢性化脓性中耳乳突炎患者术前进行螺旋CT扫描并与手术及病理结果对照分析。结果48例中,胆脂瘤型32耳,典型者表现为上鼓室、鼓窭及其入口内团块样或弥漫性软组织病灶,边缘见低密度环,骨缘硬化,鼓室扩大,盾板变钝或破坏,听小骨明显破坏;肉芽肿型28耳,主要表现为鼓室及鼓窦内软组织条索及片网影,听小骨破坏较轻;单纯型15耳,表现为中耳腔内黏膜增厚、积液。三维CT听骨链显示情况与手术一致。结论螺旋CT扫描对慢性化脓性中耳乳突炎术前诊断及分型有重要意义,三维CT成像对制定手术方案,提高手术安全性有很大价值。     

成人中耳积液243例分析

目的:探讨成人中耳积液的病因及治疗方法。方法:对243例261耳中耳积液患者的临床资料进行回顾性分析、总结。结果:治愈205耳,治愈率78.5%。其中,144耳经单纯鼓膜穿刺抽液治愈,58耳经穿刺治疗无效后改行鼓膜置管后治愈,2耳经耳内镜下鼓室探查术后治愈,1例经乳突根治术后治愈。结论:成人中耳积液的发生是多种因素相互作用的结果,其中咽鼓管功能不良、感染是最基本和最重要的因素。对成人中耳积液应采用综合治疗方法,鼓膜穿刺、鼓膜置管是最常用的局部治疗方法。积极治疗鼻、咽原发疾病是提高治愈率的关键。耳内镜下鼓室探查术对治疗顽固性成人中耳积液有一定疗效,值得临床探索。     

脑干听觉诱发电位与中内耳CT三维重建对婴幼儿听觉通路结构及听力学异常的评估价值

目的：脑干听觉诱发电位各波形反映相应神经核团的电活动，而中内耳三维CT重建可反映中内耳的结构发育情况，观察两对婴幼儿听觉通路结构异常的评估价值。方法：选择2000-10／2003-05惠州市中心人民医院收治的耳聋患儿20例，年龄≤4岁，首先进行脑干听觉诱发电位检查，提示听觉通路下段异常然后以1．0mm层厚行双耳螺旋CT扫描并对中内耳结构行表面遮盖成像法三维重建，分析中耳听骨链及内耳结构的大小、形态及脑干听觉诱发电位图形中各波潜伏期，峰间潜伏期，波形的可重复性，波V反应阈值。结果：纳入分析20例40只耳。①中内耳CT三维重建：20例40只耳中．显示中和／或内耳异常率42％(17／40)，其中中耳听骨链异常12耳，表现为慢性中耳炎听骨链异常8耳(胆脂瘤型6耳，肉芽肿型2耳)，表现为中耳听骨链异常4耳。内耳先天性发育异常5只耳(表现为半规管发育细小或不全3耳，耳蜗发育不全2耳)。余23只耳未见异常。②脑干听觉诱发电位检查：20例40耳脑干听觉诱发电位表现异常率82．5％(33／40)：其中Ⅰ波缺失，余波正常13耳，Ⅰ～Ⅴ波潜伏期缺失20耳结论：①脑干听觉诱发电位主要是通过短声刺激诱发脑干神经细胞产生电位记录，用于测试婴幼儿耳聋及高危儿，能客观地反映听力和听觉传导通路的病理障碍。②三维CT可更清楚地显示骨、砧骨及其关节的解剖结构，且可从不同角度观察其微细解剖结构间的三维空间关系，提高了因听小骨病变等骨性传导通路导致听力传导异常诊断的准确。     

鼻咽癌合并鼓室积液的治疗与放疗后的听力关系

目的：探讨鼻咽癌合并鼓室积液的患者在放疗前后是否行鼓膜穿刺抽液或鼓膜置管，并分析两组放疗后的听力变化。方法：对1997年以来确诊为鼻咽癌的患者进行追踪。选择放疗前后做过鼓室抽液或鼓膜置管的患者38耳，放疗前后未经中耳治疗的放疗后的患者32耳，进行听力学检查。采用GSI－16型纯音听力计，GSI－33型中耳分析仪，按正常听力，传导性耳聋，混合性耳聋，感音神经性耳聋分类，对其所占的比例进行比较。结果：鼻咽癌放疗前后合并鼓室积液，或疑有鼓室积液的患者，及时行鼓膜穿刺或鼓膜置管的，放疗后正常听力及传导性耳聋所占比率明显高于未做中耳治疗的患者（P＜0．05）。而感音神经性耳聋患者的比例后者明显高于前者（P＜0．05）,两者放疗后的混合性耳聋发生的比例差异无显著意义（P＞0．05）。结论：鼻咽癌合并鼓室积液，放疗前、后的中耳治疗，及时排出中耳积液，对放疗后的听力恢复有重要意义。     

镫骨赝附体与砧骨长突连接方式对声音传导的有限元分析

目的：探讨镫骨与砧骨长突的连接方式对声音传导的影响，以指导镫骨手术。方法：根据复旦大学附属中山医院提供的人体正常耳CT扫描结果，用自编软件将CT扫描数值化并导入PATRAN重建三维有限元模型，应用动力学的传导振动原理，对正常的听小骨结构进行动力数值计算分析，并与目前已报道的试验结果对比。对采用环型置换术式，用不同环直径的镫骨赝附体所重建的听骨链结构进行动力数值计算分析，并与正常的听骨链结构力学行为进行对比。结果：在环型镫骨置换术中，镫骨赝附体与砧骨长突连接处环直径的大小对镫骨的振幅有影响，即当置换环直径越小时，镫骨赝附体振幅越接近正常人体，患者听力恢复效果越佳。结论：镫骨赝附体与砧骨长突连接处环直径的大小对患者术后的听力恢复有影响。     

谈谈化脓性中耳炎

化脓性中耳炎,临床分为急性和慢性两个阶段。下面谈谈它们的临床表现和怎样防治。解剖:中耳是一个小腔,内有传导声音的三块听小骨,此腔借鼓膜与外耳道相隔,向后经鼓窦可到乳突蜂房,向前下经细长的耳咽管通到鼻咽部,耳咽管是正常人中耳与外界的唯一通道,中耳与外界的气压平衡即依它而维持。急性中耳炎的病因:正常情况下耳咽管是关     

成人中耳、内耳解剖结构螺旋CT三维成像

目的：建立成人中耳，内耳解剖结构三维立体图像模型。方法：采用螺旋CT薄层扫描（层厚1mm或2mm)，小视野（FOV=5cm)，密集重建技术（间隔0.2mm或0.5mm)，对90例成人中耳，内耳进行三维成像。包括多平面重组（MPR），最大密度投影（MIP），表面成像（SSD）和仿真内窥镜成像（CTVE）。结果：中耳彭室，听骨链，内耳及内耳道分别三维成像，全面显示了各结构相互关系。表面及内部形态。结论：螺旋CT三维成像能够全面准确观测成人中耳，内耳立体结构。     

正常及慢性化脓性中耳炎中耳结构的螺旋CT研究

目的探讨SCT(螺旋CT)对正常中耳结构(主要为听骨链)的显示及对慢性化脓性中耳炎中耳结构的诊断价值.方法 90耳(男52耳,女38耳)分三组,1组为正常SCT组30耳,2组为正常HRCT(高分辨率CT)组20耳,3组为慢性化脓性中耳炎组40耳,利用Somatom Plus 4 CT进行扫描,用SSD(表面阴影成像)、MPR(多层面重建)螺旋CT三维成像软件处理图像.结果 SCT较HRCT扫描能清楚直观地显示正常中耳结构,对一些细微结构显示较一般HRCT扫描好.对豆状突、砧镫关节、镫骨上结构显示率分别为90%、93.3%、96.6%.SCT对30耳经手术和病理证实的慢性化脓性中耳炎患者中耳结构的破坏能清晰显示.结论螺旋CT对正常中耳结构的显示及慢性化脓性中耳炎结构破坏情况有较高的价值.     

儿童大疱性鼓膜炎与中耳积液相关性分析

大疱性鼓膜炎是鼓膜及其临近外耳道的急性炎症，好发于儿童，一般不累及中耳，虽有剧烈耳痛但无穿孔及流脓现象。作1999年1月至2005年11月，诊治儿童大疱性鼓膜炎125例（140耳），其中25例（30耳）病程后期出现中耳积液，发生率20％。大疱性鼓膜炎与中耳积液的关系教科书和献上少有提及，现结合诊治病例就大疱性鼓膜炎与中耳积液相关原因作一分析。     

咽鼓管表面活性物质对气压损伤豚鼠中耳及听阈的影响

目的探讨人工咽鼓管表面活性物质(Eustachiantube surfactant,ETS)对气压损伤性中耳炎(Barotitis media,BM)的治疗作用,为临床应用提供理论依据.方法经低压舱上升实验建立气压损伤性中耳炎动物模型.成功建模豚鼠30只,于建模后的第1天,左侧中耳内注入1 mL人工ETS治疗,右侧对照注入1 mL生理盐水.结果1周后观察比较两组鼓膜状况(χ2=8.801,P＜0.05)、鼓室渗出(χ2=9.796,P＜0.05)、听阈恢复(χ2=9.810,P＜0.05),人工ETS组明显好转,与生理盐水对照组差异有显著性意义.结论人工ETS对气压损伤性中耳炎具有治疗作用.     

Non-invasive optical interferometry for the assessment of biofilm growth in the middle ear

Otitis media (OM) is the most common illness in children in the United States. Three-fourths of children under the age of three have OM at least once. Children with chronic OM, including OM with effusion and recurrent OM, will often have conductive hearing loss and communication difficulties, and need surgical treatment. Recent clinical studies provide evidence that almost all chronic OM cases are accompanied by a bacterial biofilm behind the tympanic membrane (eardrum) and within the middle ear. Biofilms are typically very thin, and cannot be recognized using a regular otoscope. Here we demonstrate how optical low coherence interferometry (LCI) noninvasively depth-ranges into the middle ear to detect and quantify biofilm microstructure. A portable diagnostic system integrating LCI with a standard video otoscope was constructed and used to detect and quantify the presence of biofilms in a newly-developed pre-clinical animal model for this condition. Using a novel classification algorithm for acquired LCI data, the system identified the presence of a biofilm with 86% sensitivity and 90% specificity, compared to histological findings. This new information on the presence of a biofilm, its structure, and its response to antibiotic treatment, will not only provide better understanding of fundamental principles that govern biofilm formation, growth, and eradication, but may also provide much needed clinical data to direct and monitor protocols for the successful management of otitis media.     

Good transfer of tebipenem into middle ear effusion conduces to the favorable clinical outcomes of tebipenem pivoxil in pediatric patients with acute otitis media

Tebipenem pivoxil, an oral carbapenem antibiotic for pediatric use, exhibits excellent clinical effects on acute otitis media (AOM). The present study was conducted to assess the pharmacokinetic profile of tebipenem in middle ear effusion and to examine the clinical efficacy of tebipenem pivoxil by calculating the values of the pharmacokinetic-pharmacodynamic parameters (AUC/MIC, C _max/MIC, and T > MIC) of tebipenem at the site of action. Twenty-three pediatric outpatients diagnosed with AOM were enrolled. Ear discharge or nasopharyngeal swabs collected before the onset of oral administration were used to conduct bacteriological examinations, and subjects were then treated by twice-a-day oral administration of tebipenem pivoxil 6 mg/kg. The clinical isolates of Streptococcus pneumoniae and Haemophilus influenzae were obtained from 10 and 19 pediatric patients (8 overlapped), respectively. On day 2 of administration, blood and middle ear effusion were collected from 20 pediatric patients to measure plasma and middle ear concentrations of tebipenem. Consequently, the C _max and the AUC_0–∞ in plasma were 5.3 ± 1.6 μg/ml (mean ± SD) and 7.9 ± 0.2 μg h/ml, respectively. The C _max in middle ear effusion of tebipenem was 1.2 ± 0.1 μg/ml, exceeding its MIC for these pathogens. The ratio of AUC_0–∞ in middle ear effusion to AUC_0–∞ in plasma was 0.36, showing the good transfer of tebipenem into the effusion; this result corroborated the known high rate of clinical efficacy of tebipenem pivoxil for patients with AOM and the low incidence of recurrence in them as manifested by the healing rate of 94.1 % (16/17).     

Human temporal bones versus mechanical model to evaluate three middle ear transducers

A life-size mechanical middle ear model and human temporal bones were used to evaluate three different middle ear transducers for implantable hearing aids: the driving rod transducer (DRT), the floating mass transducer (FMT) or vibrant sound bridge, and the contactless transducer (CLT). Results of the experiments with the mechanical model were within the range of the results for human temporal bones. However, results with the mechanical model showed better reproducibility. The handling of the mechanical model was considerably simpler and less time-consuming. Systematic variations of mounting parameters showed that the angle of the rod has virtually no effect on the output of the DRT, the mass loading on the cable of the FMT has a larger impact on the output than does the tightness of crimping, and the output level of the CLT can be increased by 10 dB by optimizing the mounting parameters.     

Impact of anaerobic and oligotrophic conditions on survival of <Emphasis Type="Italic">Alloiococcus otitidis</Emphasis>, implicated as a cause of otitis media

The survival of Alloiococcus otitidis (NCFB2890) with different nutritional supplements, including brain–heart infusion broth (BHI), phosphate-buffered saline (PBS), distilled water (DW), and middle ear effusion (MEE), as well as various atmospheres (aerobic, microaerobic, anaerobic), was compared using cultures, LIVE/DEAD staining, and transmission electron microscopy. The bacterial morphological traits and viability were maintained in BHI and MEE under aerobic conditions but were rapidly lost in PBS and DW. In contrast, anaerobic conditions did not support viability at all. Thus, the bacteria critically required an aerobic atmosphere for its survival as well as the appropriate nutrients, implying that culture of this pathogen from clinical specimens would become more difficult through oxygen depletion depending on a slight change in the middle ear atmosphere.     

Preliminary use of endoluminal ultrasonography in assessment of middle ear with effusion.

Endoluminal ultrasonography with small-caliber and high-frequency transducer is suitable for transcanal assessment of middle ear with effusion. An endoluminal ultrasound transducer (size 6 French, 20 MHz) with a side-viewing scanning plane was used to image 12 ears of six children suspected of having effusion in the middle ear. Sonographic findings were compatible with those of operation in 10 diseased ears. One false-negative result was obtained, and one trial was aborted owing to trauma to the canal wall. The present study proves utility in demonstrating fluid behind the tympanic membrane. A promising use of endoluminal ultrasonography for middle ear evaluation might be expected if some modification could be made to the transducer.     

Outcome of Acute Otitis Media with Abnormal Tympanometric Patterns in Children

Objective : To assess the ability of ED tympanometry to identify those children with acute otitis media who are at greater risk for treatment failure, recurrent infection, or persistent middle ear effusion.
Methods : A prospective observational study was performed in the EDs of a county hospital and a university medical center. One hundred seventeen children, aged 5 months to 5 years, with acute otitis media and abnormal tympanometric patterns were categorized into three groups —low compliance, high pressure, and low pressure—based on the initial patterns. All the children received oral amoxicillin for ten days. They had repeat tympanometry and otoscopy at 14- and 60-day follow-up visits, and were followed to determine clinical outcomes.
Results : Initial treatment success was equivalent for all groups: low compliance 93% (95% confidence interval 81%-97%), high pressure 91% (95% CI 71%-98%), and low pressure 89% (95% CI 59–99%). Rates of relapse, reinfection, 90-day non-recurrence, and persistent otoscopic and tympanometric middle ear effusion did not differ significantly between groups.
Conclusion : ED tympanometry of children with acute otitis media is unable to provide prognostic information regarding treatment failure, recurrent infection, or persistent middle ear effusion.     

Mucolytic agents and otitis media with effusion

Middle ear effusion was obtained from children with otitis media with effusion and separated into thick (mucoid) and thin (serous) pools. Both effusion types contained similar amounts of non-dialysable solids. However, the thick effusions contained more mucus glycoprotein than the thin effusions, 25% and 8.2% respectively. Amino acid and carbohydrate analysis of the CsCl purified mucus glycoproteins demonstrated that the glycoprotein from the thick and thin effusions differed in their protein core, those from the thick effusions possessing a higher percentage of serine and threonine, the amino acids to which the sugar side-chains attach. They are also more glycosylated. N-acetyl cysteine and mercaptoethanol caused a fall in the viscosity of solutions of purified middle ear glycoprotein and effusion homogenate. However, longer term incubation caused a rise above the starting viscosity. This effect was concentration-dependent, and was mediated by low molecular weight components in the effusion and not the mucus glycoprotein. S-carboxymethyl cysteine had no effect on the viscosity of either the purified mucus glycoprotein or the effusion homogenate. Therefore, to produce a decrease in effusion viscosity in vivo, the concentration of mucolytic reaching the middle ear and the time it remains there are critical factors.     

香菇多糖治疗老年恶性心包积液

目的观察老年恶性心包积液患者心包腔内分别灌注香菇多糖与顺铂治疗的有效性和安全性。方法45例患者随机分为A组22例,B组23例,采用中心静脉穿刺导管行心包穿刺置管引流术,A组给予灌注香菇多糖4mg＋生理盐水20ml,B组给予顺铂40mg＋生理盐水20ml。结果A组患者有效率（完全缓解率＋部分缓解率）90．9％（20／22）例,B组患者有效率60．9％（14／23）例,A组患者有效率优于B组（P〈0．05）,且A组不良反应轻微。结论对于老年恶性心包积液的患者心包腔内灌注香菇多糖有效而且安全。     

An introduction to tympanometry.

The tympanogram is an objective measure of middle ear effusion or eustachian tube dysfunction. It provides information about the compliance or mobility of the tympanic membrane, the pressure within the middle ear and the volume of the external ear canal. Tympanograms are classified as type A (normal), type B (indicating fluid behind the tympanic membrane) or type C (indicating eustachian tube dysfunction). The objective data obtained by tympanometry are a useful adjunct in the diagnosis and follow-up of middle ear disease.