细菌生物膜与慢性中耳炎

慢性化脓性中耳炎是常见的耳部疾病,在临床上对部分保守治疗患者单纯使用抗生素效果不佳,出现炎症的迁延不愈或反复发作,造成听觉细胞和听觉神经的损害,给患者带来严重后果.近年来,国内外相关研究认为细菌生物膜在慢性化脓性中耳炎迁延不愈及反复急性发作中扮演非常重要的作用.本文就细菌生物膜在中耳炎方面的研究现状做一综述.     

细菌生物膜与慢性中耳炎

慢性化脓性中耳炎是常见的耳部疾病,在临床上对部分保守治疗患者单纯使用抗生素效果不佳,出现炎症的迁延不愈或反复发作,造成听觉细胞和听觉神经的损害,给患者带来严重后果。近年来,国内外相关研究认为细菌生物膜在慢性化脓性中耳炎迁延不愈及反复急性发作中扮演非常重要的作用。本文就细菌生物膜在中耳炎方面的研究现状做一综述。     

细菌生物膜在急性中耳炎大鼠中耳腔的形成特点及意义

目的 通过观察细菌生物膜在急性中耳炎大鼠中耳腔的形成特点,分析其与急性中耳炎的关系,并探讨该中耳炎模型用于细菌生物膜研究的可行性.方法 30只健康雄性SD大鼠,采用随机数字表法分为实验组(24只)和对照组(6只).麻醉后将50μl肺炎链球菌悬液[1×108菌落形成单位(colony forming unit,CFU)/...     

慢性化脓性中耳炎细菌生物膜体外检测及耐药性研究

目的研究慢性化脓性中耳炎细菌生物膜检测及耐药机制。方法刚果红培养法观察培养基不同条件下TSB（胰酪胨大豆肉汤）,TSB-0.25%Glu（TSB-0.25%葡萄糖）,TSB-2% Alc（TSB-2%无水乙醇）,TSB-4% Alc,TSB-2% NaCl和TSB-4% NaCl生物膜生长情况,铜绿假单胞菌生物被膜分析采用银染法,K-B琼脂扩散法进行抗菌药敏试验。结果（1）刚果红培养法的培养基最佳配方为TSB-0.25% Glu,TSB-2%Alc,TSB-4%NaCl。革兰氏阳性菌中产生生物膜阳性率为48.4%,革兰氏阴性菌中产生生物膜阳性率为45%。铜绿假单胞菌生物膜产生阳性率最高;（2）有生物膜葡萄球菌对青霉素、红霉素、复方新诺明耐药,未发现耐万古霉素。有生物膜假单胞菌/变形杆菌对喹诺酮类、第三代头孢菌素和泰能（亚胺培南-西司他丁钠）敏感。结论临床治疗和细菌检验中应严格区分有无生物膜生长,对有生物膜细菌应选择抗生素的联合使用。     

中耳吹张法治疗分泌性中耳炎98例分析

1993年1月至1997年12月我们用中耳吹张法治疗分泌性中耳炎98例、134耳,现总结如下.     

慢性化脓性中耳炎病原学研究及其临床应用

目的：分析慢性化脓性中耳炎的致病菌种类及其药物敏感性。方法：取108例慢性化脓性中耳炎的外耳道深部或中耳脓液作细菌培养及药敏试验。结果：108例中培养分离出9 种细菌,其中铜绿假单胞菌占26.85%,金黄色葡萄球菌23.15%, 变形杆菌20.37%, 其他25.92%,混合感染2.78%。铜绿假单胞菌感染的病例中,亚胺培南和多粘菌素敏感试验均为阳性。结论：为避免产生耐药菌株,应根据药敏试验结果合理应用抗生素。     

慢性中耳炎细菌生物膜形成与细菌培养结果的相关性分析

目的：探讨慢性中耳炎细菌生物膜形成与细菌培养之间的相关性。方法：对32例慢性化脓性中耳炎及中耳胆脂瘤患者术中取得的样本进行扫描电镜检查,并对中耳分泌物行细菌培养;分析慢性中耳炎细菌生物膜形成与细菌培养结果之间的关系。结果：慢性化脓性中耳炎（活动期）与中耳胆脂瘤细菌生物膜形成率分别为87．5％、81．3％（P〉0．05）。慢性中耳炎扫描电镜细菌生物膜结果与细菌培养结果之间比较,灵敏度为70．37％,特异度为60.00％,误诊率为40．00％,漏诊率为29．63％,阳性预测值为90．46％,阴性预测值为27．27％,正确率为68．75％,约登指数为30．37％,Pearson相关系数为0．232（P〉0．05）。结论：慢性化脓性中耳炎（活动期）与中耳胆脂瘤均有较高的生物膜形成率,但中耳分泌物常规细菌培养结果不能反应慢性中耳炎患者细菌生物膜的形成情况,需要探索更为可靠的细菌学实验方法来准确反映慢性中耳炎的感染情况。     

转化生长因子β在分泌性中耳炎患者中耳积液和血清中的表达及意义

分泌性中耳炎(SOM)的发病机制还不十分清楚.一般认为咽鼓管阻塞、中耳负压导致血管内液体渗漏形成中耳积液.后来有学者发现咽鼓管阻塞并非是引起SOM的必要条件,而中耳积液中炎症递质和炎性细胞的发现,证实SOM是一炎症反应和渗出的结果.     

一氧化氮及两种细胞因子在分泌性中耳炎中耳积液中的表达及意义

目的　探讨一氧化氮 (NO)和白细胞介素 8(interleukin 8,IL 8)、肿瘤坏死因子 α(tumornecrosisfactor α ,TNF α)在分泌性中耳炎发生和转归中的作用。方法　检测 5 8例 (80耳 )分泌性中耳炎患者血浆和中耳积液中NO、IL 8及TNF α ,并用 2 3例健康人血浆作对照。结果　NO、IL 8及TNF α在中耳积液中阳性表达率分别为 1 0 0 %、82 2 %和 71 4 % ;患者组三者的血浆含量较对照组高 (P <0 0 5 ) ,中耳积液的含量较血浆中高 (P <0 0 1 )。病程短者IL 8含量高 (P <0 0 1 ) ;病程长者NO及TNF α含量高 (P <0 0 5 )。浆液性积液组IL 8含量高 (P <0 0 1 ) ;粘液性积液组NO及TNF α的含量高(P <0 0 5 )。NO含量与TNF α含量呈正相关。结论　NO、IL 8、TNF α可能是中耳积液形成的诸多介质中的 3种 ;IL 8在疾病早期参与机体的防御反应 ,促进浆液性中耳积液产生 ;NO和TNF α与疾病的持续状态相关 ,并参与中耳积液中粘蛋白的分泌。     

病原菌生物膜在中耳炎发生和转归中的作用

中耳炎是耳鼻咽喉头颈外科常见疾病之一。细菌、真菌等病原菌感染是中耳炎发生和发展的核心因素。此外,长期、广泛的抗生素运用使病原菌耐药性增强,从而难以彻底清除中耳感染。近年来的研究认为中耳炎的发病及病原菌耐药机制与生物膜的形成密切相关,生物膜因其自身的特性致使病菌逃逸抗生素及机体自身免疫的清除,严重影响病情,最终     

Nasal and middle ear ciliary beat frequency in chronic suppurative otitis media

The middle ear mucociliary system has been shown to have an important function in the clearance of effusions. Little is known, however, about its role in chronic suppurative otitis media (CSOM). The ciliary beat frequencies of middle ear mucosal biopsies and nasal brushings of 27 patients with CSOM were analysed using a computerized photometric technique. The ciliary beat frequency in the middle ear mucosa was significantly less than that in nasal mucosa. Frequency in ears of smoking patients was significantly lower compared with non-smoking patients. Nasal brushings were taken from 27 otherwise healthy age and sex-matched non-smoking controls and the ciliary beat frequency was very similar to nasal samples from patients with CSOM. Ear controls were obtained from otosclerotic patients undergoing tympanotomy and the beat frequency was significantly higher than in the ear of patients with CSOM. It is concluded that middle ear ciliary function is significantly reduced in CSOM, particularly in patients who smoke.     

Mucosal biofilm formation on middle-ear mucosa in a nonhuman primate model of chronic suppurative otitis media

BACKGROUND: An increased awareness of bacterial biofilms and their formation has led to a better understanding of bacterial infections that occur in the middle ear. Perhaps the best studied pathogen for its propensity toward biofilm formation is Pseudomonas aeruginosa, also the primary pathogen in chronic suppurative otitis media (CSOM). OBJECTIVE: The aim of this study was to determine whether P. aeruginosa forms a biofilm in the middle ear in the setting of CSOM in a nonhuman primate model. METHODS: Cynomolgus monkeys underwent perforation of the tympanic membrane and inoculation of the middle ear with a known biofilm-forming strain of P. aeruginosa. The contralateral ear was used as an internal control and was neither perforated nor infected. At the end of the study period, both ears were irrigated to remove planktonic bacteria, and the middle ear mucosa was removed and examined ultrastructurally using scanning electron microscopy (SEM) for determination of the presence or absence of biofilm formation. MAIN OUTCOME MEASURE: The identification of middle ear biofilm containing rod-shaped bacteria. RESULTS: SEM revealed that P. aeruginosa formed bacterial biofilm in vivo on the middle ear mucosal surface, seen only in the infected ear. Interestingly, biofilm formation caused by cocci was also seen in both the experimental as well as the control ear. CONCLUSION: P. aeruginosa forms biofilms in the middle ear in CSOM in primates. To our knowledge, this is the first report of disease-associated bacterial biofilm in a nonhuman primate model of CSOM. Such a model lays a foundation for much needed study into the role of biofilms in the pathophysiology of CSOM. Should CSOM be caused by biofilms, which is uncertain at this time, development of novel strategies for treatment and prevention may be possible. The finding of both rods and cocci forming biofilms also warrants further investigation.     

慢性化脓性中耳炎的微生物学研究进展

慢性化脓性中耳炎(CSOM)是一种常见病多发病,CSOM是一种多因素疾病,由环境、细菌、宿主和遗传危险因素等一系列因素相互作用引起,细菌感染是CSOM重要的原因之一。由于地区、民族、饮食习惯等差异,CSOM在世界各地的发病率及细菌种类也有所差异。既往基于培养技术获得CSOM部分优势菌群,但不能获得CSOM细菌群落的全貌,限制了CSOM的病原学研究。随着各项检测技术的提高,特别是16S rRNA测序及宏基因组测序等分子技术的发展,CSOM病原学研究也逐步完善,这不仅对抗生素的选择提供依据,同时也能进一步研究细菌在CSOM中的致病机制。     

Rate of isolation and trends of antimicrobial resistance of multidrug resistant pseudomonas aeruginosa from otorrhea in chronic suppurative otitis media

Objectives

To assess the rate of isolation of Pseudomonas aeruginosa (PA) and multidrug-resistant PA (MDR-PA) from patients with chronic suppurative otitis media (CSOM) otorrhea and the annual trend of antibiotic-resistance.

Methods

Otorrhea samples were collected aseptically from 1,598 CSOM patients. The rate of bacterial isolation and the results of antibiotic susceptibility testing were evaluated retrospectively.

Results

The PA isolation rate from CSOM otorrhea was 24.4%. Of the 398 isolated strains tested for their susceptibilities to 10 antibiotics, 395 strains showed definitive results. Of these, 183 (46.3%) were susceptible to whole antibiotics and 212 (53.7%) was resistant to more than 1 antibiotics, with the frequency of antibiotics-resistance increasing significantly over time. Although strains susceptible to all antibiotics decreased over time, the rate of isolation of MDR-PA did not change significantly. Resistance to aminoglycosides and quinolones was higher than to other antibiotics and significantly increased over time, whereas resistance to other antibiotics showed no trend.

Conclusion

MDR-PA, assessed using five individual antibiotics and six antibiotic-classes, showed no tendency to increase or decrease over time. This may have been due to increased concern about antibiotic-resistant bacterial strains, leading to improved infection control within hospitals and healthcare centers.     

中耳胆脂瘤及慢性化脓性中耳炎患者乳突根治术中面神经裸露及危险因素分析

目的 总结中耳胆脂瘤及慢性化脓性中耳炎患者乳突根治术中的面神经裸露情况,并分析面神经裸露的相关危险因素。方法回顾性分析2015年1月—2019年12月行乳突根治术的1 016例患者的临床资料,均为单耳患者,其中中耳胆脂瘤683耳,慢性化脓性中耳炎333耳,总结其面神经裸露情况及分布部位;采用单因素与多因素Logistic线性回归的统计方法分析年龄、性别、病程、硬脑膜暴露、半规管骨质破坏、乙状窦暴露及病理类型等因素与乳突根治术中面神经裸露的关系。结果1 016例患者中有294耳出现面神经裸露,面神经总裸露率为28.94%（294/1 016）;面神经裸露最常见的部位是水平段（264/294,89.80%）。中耳胆脂瘤的面神经裸露率为32.50%（222/683）,慢性化脓性中耳炎的面神经裸露率为21.62%（72/333）,两者差异具有统计学意义(P=0.0 003)。单因素分析结果显示病理类型、脑膜暴露、术前面瘫、半规管骨质破损及乙状窦暴露均为面神经裸露的相关因素,而与病程、年龄及性别无明显相关。进一步多因素Logistic回归分析结果示：中耳胆脂瘤、半规管骨质破坏及术前面瘫为面神经裸露的危险因素,风险分别增高1.575倍（95%CI：1.141~2.176）、4.171倍（95%CI：2.579~6.746）及13.040倍（95%CI：2.793~60.872）。结论中耳胆脂瘤及慢性化脓性中耳炎患者均可出现面神经裸露,最常见的裸露部位为水平段。半规管骨质破坏、术前面瘫及中耳胆脂瘤是乳突根治术面神经裸露的危险因素。     

慢性化脓性中耳炎并发迷路瘘管20例

目的 :探讨慢性化脓性中耳炎并发迷路瘘管的临床特征及治疗方法。方法 :回顾性分析 1992～ 1999年收治的慢性化脓性中耳炎患者 45 0例的临床资料 ,全部病例均行乳突根治术。结果 :45 0例中并发迷路瘘管 2 0例 (4 .4% ) ,18例 (90 % )有主观听力下降 ,13例 (6 5 % )有眩晕史。 9例 (4 5 % )瘘管试验阳性。患耳全聋 2例 ,患耳纯音测听骨导平均听阈≤ 30 d B 11例 ,31～ 5 0 d B 3例 ,≥ 5 1d B 4例。瘘管试验阳性患者患耳听力较瘘管试验阴性者差 (P <0 .0 1)。 CT检查的 9例中 ,2例发现迷路瘘管。术中发现 18例 (90 % )为胆脂瘤性中耳炎 ,2例 (10 % )为骨疡型中耳炎 ,瘘管均发生在外半规管。结论 :迷路瘘管术前尚无可靠的诊断方法 ,最可靠的方法是在手术中探查。对迷路瘘管区的处理应视瘘管的大小、部位、病变性质及患者的具体情况而定。     

The role of retinol in the etiology and outcome of suppurative otitis media

Vitamin A deficiency is still a serious public health problem affecting an estimated 127 million preschool children. The resulting immunological dysfunctions lead to increased risks of respiratory tract infections, diarrhoeal diseases and blindness, among others. The aim of this study is to determine the significance of the role of serum retinol in the etiology of acute suppurative otitis media (ASOM) and its chronicity (CSOM). In a prospective follow-up of patients with ASOM for 6–9 months, serum retinol determination was done using the high performance liquid chromatography. Participants comprised 358 ASOM and 52 control subjects. Six-month follow-up was achieved in 264 subjects (74%); of these, there was persistence of otorrhoea (CSOM) in 116, while 148 had resolved ASOM. Of the 264 subjects, 146 were males and 118 were females, between the ages of 6 months and 9 years and a mean of 7 years (SD = 2.32), whereas the control subjects comprised 29 males and 22 females, between the ages of 6 months and 11 years and a mean of 7.8 years (SD = 3.6). The range of serum retinol in the ASOM subjects was 1.63–2.64 μg/L, mean of 1.53 μg/L, median value of 2.61 μg/L and (SD = 0.16). Among control subjects, the range was 2.5–2.8 μg/L, mean of 2.58 μg/L and median value of 2.61 μg/L (SD = 0.14) (Table 1). The range of serum retinol in the resolved ASOM subjects was 1.61–2.63 μg/L, mean of 2.07 μg/L and median value of 2.09 μg/L (SD = 0.16) while the CSOM subjects ranged between 0.8–2.86 μg/L, mean of 1.58 μg/L and median value of 1.28 μg/L, (SD = 0.48) (Table 2). Univariate analysis using unpaired t test to compare the mean serum retinol revealed significant difference between ASOM and control (P = 0.0000) and between resolved ASOM and CSOM (P = 0.0000). In conclusion, hyporetinolaemia was a significant etiological factor in the etiology ASOM and CSOM, suggesting retinol supplementation as one strategy in control of SOM.     

Clinical and demographic risk factors associated with chronic suppurative otitis media

BACKGROUND: The incidence of chronic suppurative otitis media (CSOM) is high worldwide but increasing occurrence of complications appear peculiar to West Africa. However, knowledge of associated risk factors is sparse, we report the sociodemographic risk factors of CSOM with the aim of control of the disease and complications; and possible preventive strategies. METHOD: This is a survey of children with CSOM in five sites spread in two suburban cities in two states in Nigeria. Questionnaire was administered on the informants followed by examination of the children. RESULT: Of the 189 children, 114 (60%) had developed ear suppuration before 6 months of age, the number of attacks within the previous 18 months ranged between 2-12 with average of 7. Sociodemographic risk factors included low socioeconomic class in 153 (81%), 136 (72%) live in congested houses with more than 10 people and 79 (42%) belonged to families with more than 5 children. Indoor-cooking and infant daycare attendance were 117 (62%) while supine bottlefeeding was 115 (61%) and 34 (18%) of subjects had smoking father. The clinical risk factors were upper respiratory tract infection (URI) 85 (45%), allergy 53 (28%), adenoid 54 (28%) and malnutrition 65 (34%). The univariate analysis revealed that low social class (OR=7.33, CI=4.18-12.83, P=0.0001), malnutrition (OR=3.57, CI=1.88-6.76, P=0.00001), bottlefeeding (OR=2.93, CI=1.63-5.28, P=0.0001), indoor-cooking (OR=1.35, CI=0.88-2.10, P=0.161) and high number of people in a household (OR=0.59, CI=0.34-0.98, P=0.04) are significant in development of OM; while multivariate logistic regression analysis showed malnutrition (OR=3.48, CI=1.633-7.425, P=0.001), low social status (OR=7.74, CI=4.15-14.43, P=0.0001) and indoor-cooking (OR=2.34, CI=1.18-4.66, P=0.014), second table. Parental smoking, daycare attendance, allergy, adenoiditis/adenoidal hypertrophy and upper respiratory tract infection were not found significant. CONCLUSION: Low socioeconomic class, malnutrition, congestion from high number of children in the household and bottlefeeding constitute significant risk factor. The early onset of disease (<6 months) may suggest a prenatal predisposition. We need further research for the understanding of the biologic effect of these factors while this remains a database for prevention and control of disease.