吡哌酸滴耳剂治疗化脓性中耳炎的临床观察

目的:观察吡哌酸滴耳剂治疗化脓性中耳炎的疗效.方法:应用0.2%吡哌酸滴耳剂治疗40例慢性中耳炎患者,疗程7d,分别于用药后第3天和第7天进行临床症状、体征及细菌学检查;同时用0.25%的氯霉素滴耳剂作对照.结果:吡哌酸滴耳剂3d后有效率和细菌清除率为65%和60%,7d后分别为92.5%和90%,氯霉素滴耳剂临床有效率和细菌清除率3d为42.5%和40%,7d后分别为62.5%和60%,差异有显著性(P<0.01).结论:吡哌酸滴耳剂治疗慢性化脓性中耳炎高效、安全.     

泰利必妥滴耳剂在胆脂瘤型中耳炎术中用药的临床及细菌学观察

观察胆脂瘤型中耳炎患者术中用泰利必妥滴耳剂治疗感染病灶的临床效果及安全性。方法将胆脂瘤型中耳炎病例随机分为两组：泰利必妥组２３例,硼酸组１９例。所有患者均行开放式鼓室成形术,并分别用０．３％泰利必妥和４％硼酸行术腔浸泡冲洗。结果临床治愈率分别为８２．６％、５０．０％     

Combined drug therapy in patients with chronic otitis media and mucositis

The data of the authors own studies using conservative therapy in patients with chronic otitis media (COM) and mucositis are presented. The efficiency of treatment of these patients is shown depending on the method of treatment (the highest efficiency being noted in the main group of patients in whom the altered middle ear mucosa was concurrently exposed to autoserum (AS) and magnetic laser therapy (MLT). The efficiency of this or that conservative treatment was found to be related to the magnitude of altered middle ear mucosal changes: the more marked the signs of mucositis are, the more difficult it is to achieve a positive result. The results of treatment were assessed visually (under an operating microscope), bacteriologically, cytologically, and crystallographically. There was a correlation between the visual assessment of obtained treatment results and crystallographic findings. The high efficiency of the proposed treatment in patients with COM and mucositis is determined by the concurrent combined AS and MLT exposure of the entire thickness of the changed mucosa and by the stimulating action of MLT on AS. This conservative therapy can pretend to be the method of choice in treating patients with COM and mucositis.     

耳内镜下手术治疗上鼓室胆脂瘤型中耳炎

目的：探讨提高局限于上鼓室的胆脂瘤型中耳炎疗效的手术方法。方法：对32例(32耳)局限于上鼓室的胆脂瘤型中耳炎患者行内镜下微创手术治疗。结果：32例中，28例1个月内干耳，15例术后听力提高，13例鼓膜穿孔愈合。结论：耳内镜下微创手术治疗局限于上鼓室的胆脂瘤型中耳炎，早期治疗，彻底清除病灶，可阻止胆脂瘤的进一步发展，防止并发症的发生。     

A systematic review of the effectiveness of ofloxaxin otic solution for the treatment of suppurative otitis media

The objectives of the study were to determine the effectiveness and incidence of adverse events of ofloxacin otic solution for suppurative otitis media compared with other treatments. All randomized controlled trials and nonrandomized comparative clinical trials published from 1966 to 2000 using ofloxacin otic solution as one of the interventions were reviewed and data were extracted and analyzed. Eleven clinical trials (9 randomized and 2 nonrandomized) enrolling 1,484 adults and children were finally included in the analysis. Five studies employed clear concealment procedure in the allocation of treatment whereas evaluation of outcome was at least single-blinded in 6 trials. The probability of overall cure rate was higher with 0.3% ofloxacin otic solution than with other topical or systemic antibiotics in 9 of the studies analyzed (OR = 2.67; 95% CI = 2.04, 3.50). Resolution of secondary outcome parameters evaluated at least 1 week after treatment was higher with 0.3% ofloxacin otic solution: resolution of otalgia (4 trials; OR = 2.41; 95% CI = 1.2, 4.82); resolution of otorrhea (11 trials; OR = 2.78; 95% CI = 2.12, 3.65), and bacterial eradication rate (6 trials; OR = 3.86; 95% CI = 2.54, 5.87). A subgroup analysis of 4 studies comparing ofloxacin otic solution with antibiotic- and steroid-containing otic solution showed a higher cure rate for ofloxacin otic solution (OR = 2.73; 95% CI = 1.52, 4.90). Another subgroup analysis on 3 studies comparing ofloxacin otic solution with oral systemic antibiotics showed higher resolution of otorrhea with ofloxacin otic solution (OR = 2.78; 95% CI = 2.12, 3.65). Of 4 studies with data on adverse events, the probability of adverse events was lower with ofloxacin otic solution than with other topical antibiotics (OR = 0.28; 95% CI = 0.19, 0.42). Subgroup analysis showed that 0.3% ofloxacin otic solution showed better results in terms of overall cure rate, resolution of otorrhea, otalgia, bacterial eradication rate and incidence of adverse events. Whether due to chronic suppurative otitis media (CSOM) or draining tympanostomy tube, the overall cure rate (CSOM OR = 4.86; with tympanostomy tube OR = 2.13) and resolution of otorrhea (CSOM OR = 4.42; with tympanostomy tube OR = 1.66) were likewise in favor of 0.3% ofloxacin otic solution. The studies included in this meta-analysis showed generally homogenous results in all clinical and laboratory outcomes analyzed, except for the evaluation of adverse events. The authors conclude that 0.3% ofloxacin otic solution is better than other otic antibiotic drops and other oral antibiotics in terms of overall cure rate and resolution of secondary outcome parameters. Estimates on the beneficial effects of ofloxacin otic solution are limited to the period of study included in this review.     

老年慢性化脓性中耳炎患者听力学分析

目的 探讨老年慢性化脓性中耳炎患者的听力学特点。方法 回顾性分析68例≥60岁单侧慢性化脓性中耳炎患者的语频（0.5、1.0、2.0、4.0kHz）纯音测听结果、术中所见中耳病变组织特点和听骨链病变情况、病变组织病理检查结果。结果 语频范围内,患耳气导、除4kHz外的骨导阈值均高于对侧耳;胆脂瘤患者与非胆脂瘤患者的气、骨导阈无明显差异;听骨链完好者与破坏者（中断或固定）的气导、2kHz骨导阈值差异具有统计学意义,0.5、1.0、4.0kHz骨导阈值差异不显著。结论 老年慢性化脓性中耳炎患者的听力改变有其独特性,掌握老年慢性化脓性中耳炎患者的听力学特征有助于疾病的诊治。     

53例慢性化脓性中耳炎患者分泌物细菌培养及药敏学分析

目的 分析53例慢性化脓性中耳炎患者分泌物细菌分布及药敏学的数据结果, 探讨此类患者的临床用药方案。方法 采用VITEK-2 COMPACT微生物分析系统对近3年住院的53例慢性化脓性中耳炎患者分泌物进行病原菌分离鉴定与药敏试验, 进行总结统计。结果 53份分泌物培养出微生物的有45份, 检出率为84.9%, 共培养出微生物49株, 其中革兰阳性球菌21株, 占42.9%;革兰阴性杆菌 21株, 占42.9%;真菌7株, 占14.2%。检出主要病原菌为铜绿假单胞菌, 占22.4%, 其次为表皮葡萄球菌、金黄色葡萄球菌, 分别占16.3%、14.3%。常见革兰阳性菌、革兰阴性菌对临床常用药物左氧氟沙星均有较高敏感性(分别为81.0%、90.9%)。结论 铜绿假单胞菌、表皮葡萄球菌、金黄色葡萄球菌是常见慢性化脓性中耳炎感染细菌, 对临床常用药物(如左氧氟沙星)有较高敏感性。而对常用药物治疗不敏感的病例要警惕细菌耐药可能, 及时行细菌培养, 真菌感染不容忽视。     

中耳乳突结核7例临床分析

我科自1990～1998年共收治7例（8耳）中耳乳突结核患者,临床表现为耳漏,中耳胶粘膜苍白肉芽。术前明确诊断结核2耳,术前诊断为急性中耳乳突炎2耳,慢性化脓性中耳炎3耳,乳突根治术后感染1耳,此6耳经术后病理证实为结核病变。8耳均行乳突根治术清除病灶结合抗痨治疗,随访2月～2年,局部病变无复发。文中对中耳乳突结核的病因、诊断、鉴别诊断及治疗方法进行了讨论。     

Clinical efficacy of an antiallergic drug on otitis media with effusion in association with allergic rhinitis

OBJECTIVE: The effect of azelastine hydrochloride (AZ), an oral antiallergic drug, was evaluated in patients displaying otitis media with effusion (OME) accompanying allergic rhinitis. METHODS: A total of 53 patients diagnosed with OME accompanied by symptomatic perennial allergic rhinitis were randomized to receive in an open fashion 2 mg of AZ in combination with 750 mg of S-carboxymethyl cysteine (SCMC) per day, or 750 mg of SCMC only (controls) for 8 weeks. Efficacy was assessed according to the global improvement rating (GIR) of six nasal or four ear symptoms or signs. RESULTS: Patients treated with AZ and SCMC had superior improvements in their nasal symptom GIRs compared to controls overall across the 8 week trial, but not in their ear symptom GIRs. However, the clinical course of patients treated with AZ and SCMC tended to be better than that of patients treated with SCMC only, and the nasal and ear symptom GIRs were significantly correlated in the AZ-treated group. CONCLUSION: These data suggest that AZ may not provide direct efficacy on the ear symptoms in OME patients with allergic rhinitis, but that there might be a possibility of its indirect efficacy in the patients in part by relieving the allergic rhinitis.     

伴有分泌性中耳炎的人工耳蜗植入适应证与手术时机

目的 探讨伴有分泌性中耳炎的人工耳蜗植入手术适应证与手术时机.方法 对26例伴有分泌性中耳炎的重度或极莆度耳聋患儿行人工耳蜗植入手术,术前对分泌性中耳炎进行必要的非手术治疗,选择手术适应证和手术时机.人工耳蜗植入术中清理分泌性中耳炎病变、通畅引流,术后定期随访,同步进行人工耳蜗植入效果的评估.结果 26例伴有分泌性中耳炎的人工耳蜗植入者均进行单侧耳手术,手术一次成功,其中左耳5例,右耳21例.术后1个月开机调试,26例均有主观电听觉.术后随访13个月～4.3年,分泌性中耳炎痊愈19例,鼓膜形态正常、声导抗检查为A型鼓室压曲线;分泌性中耳炎好转7例,鼓膜轻度浑浊内陷,声导抗吃不开C型鼓室压曲线;无鼓膜穿孔、中耳粘连或分泌性中耳炎急性发作病例.结论 伴有分泌性中耳炎的人工耳蜗植入手术在严格掌握手术适应证的前提下,应及早手术,以争取术后听觉言语康复的最佳时期;通过术前必要的药物治疗、术中的病变处理与术后的治疗以及密切随访,都可以避免并发症的发生,达到人工耳蜗植入的预期效果.     

Hearing disorders in patients with adhesive otitis media

This paper presents the results of audiological examinations of 76 patients, aged 18 to 60 years, with adhesive nonperforative otitis media. The hearing function was measured in terms of threshold tonal audiometry, ultrasound hearing sensitivity, lower limit of sound frequency perception, discomfortable loudness, dynamic range of the hearing field, speech intelligibility in the masking noisy environment. In 30% of cases hypoacusis accompanying adhesive otitis media showed symptoms that were similar to those of hypoacusis resulting from inner ear pathologies (descending audiometric curves with high hearing thresholds related to bone conduction and small bone-air interval, high thresholds of ultrasound perception, normal lower limits of sound frequency perception and positive recruitment). Study of speech intellibility in a masking noisy environment can be a good test for the diagnosis of adhesive otitis media, including the cases aggravated with secondary cochlear neuritis. The pathognomonic parameter is good speech intelligibility in both silent and noisy environments.     

Cochlear implantation in patients with chronic otitis media

Objective

Patients with complications of otitis media present a significant challenge to safe cochlear implantation. We describe our experience of cochlear implantation in patients with chronic ear disease, and propose management principles according to the presenting status of the ear.

Methods

Cochlear implantations were performed as treatment for complications of otitis media in seven patients. They consisted of four patients with adhesive otitis media, two patients with an open cavity after surgery for otitis media and one patient with eosinophilic otitis media.The electrodes were inserted by an approach via the external auditory canal in patients with poor growth of the mastoid antrum or adhesion of the tympanum. For the patients with an open cavity, we created a posterior wall for the external auditory canal and perform the mastoid obliteration. Modified Rambo's technique with blind sac closure of the external auditory canal was performed for the case of eosinophilic otitis media as a single-stage procedure.

Results

The post-operative courses were good. However, a post-operative infection developed in one patient who had previously undergone radiation therapy following surgical excision of a cerebellar tumor.

Conclusion

Transcanal approach is effective in a poorly pneumatized mastoid or severe adhesive otitis media.A decision whether implantation as a single-stage or multiple stages depends on the condition of each cases. But there is a possibility of infection even if we selected a stage operation.     

Surgery in elderly patients with chronic otitis media

The results of surgery in 75 ears in patients over 60 years of age affected by chronic otitis media were compared with the results of surgery in 693 ears in patients under 60 years of age affected by chronic otitis media. Results in the elderly patients were found to be as good as those in the younger patients. No severe complications of surgery occurred in the patients over 60 years of age. The authors recommend that surgery should be undertaken on ears of elderly patients affected by chronic otitis media on the basis of the same indications as in younger patients.     

Epidemiological analysis of otitis media with effusion in children

A study was conducted on 153 children with otitis media with effusion to assess risk factors for otitis media with effusion. Information was collected by questionnaire survey, clinical examination and audiological tests including tympanography. We investigated two groups of children with otitis media with effusion. Group 1 consisted of 70 children with otitis media with effusion who had not undergone myringotomy. Group 2 consisted of 83 children with otitis media with effusion who had undergone myringotomy. Bottle feeding and adenoidal hypertrophy occurred more frequently in Group 2 than in Group 1. These observations provide an epidemiologic and clinical basis for further investigations of otitis media with effusion.     

Tuberculous otitis media: a clinical and radiologic analysis of 52 patients

OBJECTIVE: This retrospective study reports on the clinical and radiologic features and the treatment outcomes of patients with tuberculous otitis media (TOM). METHODS: We reviewed the medical records of 52 patients (53 ears) with TOM between 1993 and 2005 and analyzed temporal bone computed tomography scans of 23 patients. The diagnosis of TOM was made if a specimen of the middle ear revealed the presence of acid fast bacilli (AFB), grew Mycobacterium tuberculosis (M. Tb) on a culture, revealed characteristic histology, and/or was positive for polymerase chain reaction (PCR) for M. Tb. RESULTS: The highest incidence of the disease was observed among patients in their 30s. The main symptom was otorrhea, and the duration of symptoms was shorter than with nonspecific chronic otitis media. Most patients demonstrated a moderate to severe hearing loss. Five patients (9.6%) demonstrated a peripheral-type facial palsy. Temporal bone CT scans demonstrated relatively well-pneumatized mastoids and occupation by soft tissue of the entire tympanum and mastoid air cells. Six patients demonstrated bone destruction that involved the cortex of the mastoid bone. In most patients, antituberculous medication was effective treatment. The patients who underwent chemotherapy after surgery achieved more rapid healing of the ear and more frequent closure of the tympanic membrane than those who did not receive surgery. CONCLUSIONS: Clinicians should have a high index of suspicion and be aware of the clinical and radiologic characteristics of TOM.     

Effectiveness of myringoplasty in patients with eosinophilic otitis media

ObjectiveTo determine whether myringoplasty can be an effective tool to control eosinophilic otitis media and improve hearing.MethodsSeverity scores for patients with eosinophilic otitis media with or without myringoplasty were retrospectively analyzed. Surgical outcomes were assessed and compared to those of patients with control: chronic otitis media with tympanic membrane perforation.ResultsThe average eosinophilic otitis media severity score for the patients with myringoplasty was significantly lower after than before surgery (P = 0.004), although the score for the group without myringoplasty remained stable during the study period. The success rate for graft uptake was 87.5%, and a statistically significant improvement was observed in the postoperative air conduction hearing level within the speech range (mean ± standard deviation; 41.5 ± 12.3 to 34.6 ± 9.22 dB; P = 0.0026) for patients with eosinophilic otitis media.ConclusionMyringoplasty contributed to decreased postoperative eosinophilic otitis media severity scores and should be considered to protect the patients from recurrent bacterial infections and pathogenic antigen parasitism in the middle ear.     

Expression of aquaporins mRNAs in patients with otitis media

Objective: This study analyzed the associations between measured levels of aquaporin (AQP) mRNAs and clinical manifestations in patients with various types of otitis media (OM).

Methods: AQP1, 2, 3, 4, 5, 6, 8, and 10 mRNA levels were assayed by real-time PCR from 57 patients with chronic otitis media (COM), 24 patients with cholesteatomatous otitis media (choleOM), and 82 patients with otitis media with effusion (OME). The relationships of these mRNA levels with the presence of bacteria, the type of hearing loss, and clinical manifestations of OM types were evaluated.

Results: All eight AQP mRNAs were expressed in inflammatory tissue, chole matrix, and effusion fluid obtained from all 163 patients with OM. The levels in OME of AQP2, 4, 6, and 10 mRNA; and the levels in choleOM of AQP1, 3, 4, and 10 mRNA were elevated significantly compared to the corresponding levels in COM (p?p?Conclusions: The levels of expression of AQP mRNA are associated with the pathophysiology of OM.