中耳炎区域性病理差异现象的研究及临床意义

目的　研究中耳炎病理过程中 ,中耳腔系统各不同区域病变特点、严重程度的差异及其原因和临床意义。方法　以 2 90耳各型伴炎性渗出液的中耳炎颞骨连续切片作为研究材料 ,将中耳腔系统分为咽鼓管区、前半 后下中鼓室区、听骨链区 (包括后上中鼓室、上鼓室区 )、鼓窦 乳突区分区进行组织病理学比较观察研究。结合 2 5 6耳各型慢性中耳炎薄层CT检查和其中 189耳手术中分区观察结果 ,对各分区病变特点和严重程度差异进行分析。结果　中耳炎时咽鼓管区几乎没有炎性病理变化 ;前半 后下中鼓室区病变轻 ,且多为可逆性病变 ;而听骨链区和鼓窦 乳突区病变明显比前两区严重 ,且多为顽固性或不可逆性病变。结论　这种“中耳炎区域性病理差异现象”是中耳腔系统前、后区域解剖结构、组织的特殊性引起中耳炎时内通风系统病理性阻塞 ,后部区域炎性渗出液易于积存并形成肉芽组织所造成的     

中耳炎隐蔽性发病的病理因素探讨

为探讨中耳炎的隐蔽性发病的病理因素，用光镜对３０６耳各型中耳炎颞骨连续切片，进行病理学观察研究和临床资料复习。结果示，绝大多数中耳炎病变过程中缺少临床症状。     

Eustachian tube function in patients with eosinophilic otitis media associated with bronchial asthma evaluated by sonotubometry

OBJECTIVE: To determine eustachian tube function in patients with asthma and with or without eosinophilic otitis media (EOM), a new middle ear disease entity with a highly viscous middle ear effusion containing many eosinophils and usually associated with bronchial asthma. One of the most important causes of otitis media (OM) is eustachian tube dysfunction. DESIGN: Retrospective case review. SETTING: A referral center. PATIENTS: Twenty patients with EOM and patients with asthma but without OM. MAIN OUTCOME MEASURES: We studied eustachian tube function using sonotubometry and a questionnaire. Sonotubometry was also performed on 13 control patients with chronic otitis media (COM) and 7 normal controls. RESULTS: The tubal opening duration was significantly longer in patients with EOM than in patients with asthma but without OM, controls with COM, and normal controls, indicating the presence of patulous eustachian tubes in patients with EOM. Responses to the questionnaire also supported the presence of patulous eustachian tubes in the patients with EOM. CONCLUSIONS: The presence of a patulous eustachian tube may be a major cause of EOM in patients with bronchial asthma. In patients with asthma who have a helper T-cell 2-dominant predisposition, a patulous eustachian tube easily allows the entry of antigenic materials into the middle ear, causing eosinophil-dominant inflammation.     

The thickness and the pathological findings of the tympanic membranes in otitis media with effusion--a pathological study of the temporal bone

The purpose of this study is to examine the relation of the grade of the inflammation of the middle ear and the pathological findings of the tympanic membranes using human serial horizontal sections from 16 temporal bones with otitis media with effusion. As controls, we used 96 normal temporal bones. The results were as follows. 1) In cases with a lot of inflammation cells in the middle ear effusion, there were seen much pathological changes in the epidermal layer and the intermediate layer. 2) In the pars flaccida and the posterior point of the malleus handle were noted remarkable changes. 3) The greater part of the cells of the middle ear effusion was neutrophils.     

Identification of MUC5B mucin gene in human middle ear with chronic otitis media

OBJECTIVES: To identify the mucin gene and its expressing cells in the middle ear mucosa with chronic otitis media (COM), and to study the correlation between infiltration of inflammatory cells in the submucosa and expression of the mucin gene in the mucosal epithelium with COM. STUDY DESIGN: Middle ear mucosal specimens removed from the inferior promontory area of 19 patients undergoing middle ear surgery for COM were studied. METHODS: Sections were stained with H&E, Alcian blue-periodic acid Schiff (AB-PAS), polyclonal MUC5B antibody, and specific MUC5B riboprobe for histological, histochemical, immunohistochemical, and mucin mRNA analyses. RESULTS: H&E staining revealed pseudostratified epithelia in 18 of the middle ear specimens with COM and cuboidal secretory epithelia in one. AB-PAS staining of epithelia revealed abundant secretory cells and their products (glycoconjugates). In situ hybridization and immunohistochemistry studies demonstrated that the secretory cells of the middle ear mucosa with COM expressed MUC5B mucin mRNA and its product MUC5B mucin. CONCLUSIONS: The MUC5B mucin gene and its product were identified in the middle ear secretory cells of patients with COM. Its expression was extensive in pseudostratified mucosal epithelia and related to infiltration of inflammatory cells in the submucosa of the middle ear cleft with COM, suggestive that inflammatory cell products are involved in the production of MUC5B.     

胆脂瘤型中耳炎形成的局部炎性浸润和刺激的病理机理研究

目的研究胆脂瘤型中耳炎形成的病理机理。方法对12例(12耳)人鼓膜内陷囊袋颞骨连续切片进行光镜组织病理学观察，重点对内陷囊袋的部位及其内侧面局部中耳腔炎性病变情况进行观察；对11例(11耳)人胆脂瘤型中耳炎进行颞骨连续切片组织病理学观察；对33耳胆脂瘤型中耳炎进行术中观察。结果12耳鼓膜内陷囊袋发生于鼓膜松弛部或(和)紧张部后上象限，囊袋内观察到不同程度的鳞状上皮增生、角化、脱落，其内侧面局部中耳腔有黏膜下炎性细胞浸润、炎性渗出液、粘连和肉芽组织等炎性病变，而其未内陷部分的鼓膜内侧面未见炎性病变。11例胆脂瘤型中耳炎的颞骨连续切片组织病理学和33例胆脂瘤型中耳炎术中观察都显示胆脂瘤全部侵占听骨链区，侵入前半中耳腔者分别为3耳和5耳，对听骨有不同程度的吸收破坏。结论中耳炎时，中耳听骨链区域局部炎性病变向内粘连鼓膜后上象限或松弛部形成内陷囊袋，并长期炎性浸润和刺激，囊袋内鳞状上皮过度增生、角化、脱落、堆积而导致胆脂瘤型中耳炎。     

Bacterial quantification--a necessary complement for the comprehension of middle ear inflammations.

Quantification of bacteria in various types of middle ear effusion (MEE) obtained during current acute otitis media (AOM), otitis media with effusion (OME) and chronic suppurative otitis media (COM) was performed. The bacteria were stained with acridine orange and their number per ml effusion evaluated under the fluorescence microscope according to a method described in detail elsewhere. During AOM, 53% of the MEE samples were culture-positive and contained 10(6)-10(8) bacteria per ml (median value 10(7) per ml). During OME, serous effusion and 78% of the mucoid effusions contained no bacteria whatsoever, whereas the remaining mucoid effusions contained 10(4)-5 x 10(5) bacteria per ml (median value 10(4) per ml). Mucopurulent effusions contained 6 x 10(5)-10(8) bacteria per ml (median value 5 x 10(6) per ml). During COM, purulent MEE had 6 x 10(6)-10(9) bacteria per ml (median value 10(8) per ml). Quantification of bacteria involved in middle ear diseases provides further information about the etiopathogenesis and appropriate management of various pathological conditions of the middle ear.     

First forty-eight hours of developing otitis media: an experimental study

The early inflammatory changes in the tympanic membrane were explored in 2 rat models. Acute otitis media was induced by instillation of Streptococcus pneumoniae type 3 into the middle ear cavity, and otitis media with effusion was induced by blockage of the eustachian tube. Otomicroscopic examination was performed before the rats were painlessly sacrificed at 3, 6, 9, 12, 18, 24, or 48 hours after initiation of the otitis media conditions. The tympanic membrane was studied by light and electron microscopy. Both acute otitis media and otitis media with effusion caused early inflammatory changes of the tympanic membrane, and the pars flaccida was the portion that reacted first. The inflammatory alterations were most pronounced in the acute otitis media model. The course of inflammation showed a bimodal pattern with an early deposition of a filamentous material with a band pattern, typical of fibrin. Despite a fluid-filled middle ear cavity, the inflammatory changes in the otitis media with effusion model were moderate, as was consistent with the clinical appearance of the tympanic membrane.     

A Model of Spontaneous Chronic Otitis Media with Effusion in Mice with ENU Induced Mutations

Background Chronic otitis media (COM) is a significant clinical problem. Understanding the mechanisms of COM is critical for its control and treatment. However, little is known of the processes leading to COM as a result of lack of animal models of N-ethyl-N-nitrosourea (ENU) induced mutations in otitis media with effusion (OME). Methods Otoscopy and auditory brain response(ABR) evaluation were carried out under sedation in Nmf391 nmf/nmf mice of 2, 4, 6 and 8 months of age. The mice were killed for study of middle and inner ear pathology. Results Tympanic membrane visualization and ABR thresholds in 1- to 8-month-old Nmf391 nmf/nmf mice showed spontaneous OME and inner ear diseases in approximately 100% of the animals.The significant elevation of ABR thresholds suggested a sensorineural component in hearing loss in addition to the conductive loss. Middle and inner ear histology showed various degrees of outer hair cells loss and middle ear inflammation in all the mice, but no inflammation cells in the inner ear. The ABR threshold at 32 kHz was significantly elevated. Conclusions This study shows histopathologic changes in the Nmf391 nmf/nmf mouse model of COM with effusion that have not been reported in human COM. This ENU induced mutation model of COM will be valuable for the characterization of middle ear inflammation and inner ear disease processes that are induced by middle ear infections. We propose that COM with effusion in this ENU induced mutation model is the cause of the cochlea hair cells damage.     

Experimental otitis media with effusion induced by middle ear effusion.

Experimental otitis media with effusion was induced in chinchillas by middle ear effusion, which was induced by an injection of immune complex into the tympanic cavity. To elucidate the pathogenesis of otitis media with effusion, cytologic and biochemical findings of the effusion and histopathology of the middle ear mucosa of effusion-induced chinchillas were compared with those of experimental otitis media with effusion induced by different procedures; eustachian tube obstruction, intratympanic inoculation of endotoxin, and immune reaction. No significant differences were seen in cytology, biochemistry, and histopathology among OMEs induced by these procedures. However, middle ear effusions, when compared with the corresponding sera, were proven to contain higher amounts of histamine and prostaglandin E2. These findings seem to demonstrate that middle ear effusion containing a large number of inflammatory mediators is essential for induction and prolongation of inflammatory reaction in the middle ear.