不同类型鼓室图患者中耳共振频率分析

目的 探讨不同类型鼓室图患者的听力损失情况及其对应的中耳共振频率变化。方法 使用听力计对患者进行纯音测听检查,了解其听力损失的性质、程度;使用中耳分析仪进行常规中耳功能分析,根据不同类型的静态鼓室图形进行分组;分别对听力正常组(30耳)、异常组(116耳)［鼓室图为A型(30耳)、Ad型(22耳)、As型(21耳)和C型(43耳)］行中耳共振频率检查。结果 正常组的中耳共振频率为(951.00±198.85)Hz;听力异常组中A型鼓室图的中耳共振频率为(861.00±137.60) Hz (P<0.01), Ad型为(725.00±158.14) Hz (P<0.01), C型为(499.00±146.27) Hz(P<0.01),三组中耳共振频率分别比正常组低;As型为(1088.00±199.38) Hz(P<0.05)比正常组高。结论 中耳共振频率的检测有助于中耳疾病的诊断及治疗。     

实验性中耳积液大鼠的鼓室导抗图测试

目的 建立客观、稳定的检测大鼠中耳积液的方法。方法 将健康SD大鼠15只（30耳）建立实验性中耳职液大鼠模型，利用GSI－33Version Ⅱ型中耳分析仪，加用自制探头，分别对建立模型前后的大鼠进行鼓室导抗图检测，获取相关指标。结果 正常大鼠鼓室导抗图测试图型为A型或As型，大鼠中耳积液模型的鼓室导抗图测试有26耳变为B型，4耳仍为有峰型图但其导纳值、峰压值和梯度值均发生相应变化。造模前后大鼠鼓室导抗图曲线平滑，A型和As型对称性较好。结论 鼓室导抗图测试能够稳定、客观、敏感地反映大鼠的中耳传音功能。     

婴幼儿低频探测音鼓室导抗测试与中耳CT测试结果的比较

目的:探讨226Hz探测音鼓室导抗测试在婴幼儿分泌性中耳炎患者中的诊断价值。方法:以听力复筛未通过的52例新生儿作为研究对象,均行226Hz探测音鼓室导抗测试和颞骨螺旋CT扫描,比较二者的诊断一致率,计算其Kappa值(κ值)。结果采用SPSS16.0软件包进行统计学分析。结果:52例(104耳)患儿中,经CT检查中耳正常者47耳,有中耳积液57耳。CT检查正常的47耳中,有24耳鼓室导抗图为"A"型(51.06%),1耳为"B"型(2.13%),1耳为"C"型(2.13%),21耳为"D"型(44.68%);CT检查有中耳积液57耳中,44耳为"A"型(77.19%),2耳为"B"型(3.51%),11耳为"D"型(19.30%);226Hz探测音鼓室导抗测试与CT测试结果的诊断一致率较低,κ=0.103。结论:226Hz探测音鼓室导抗测试与螺旋CT测试结果诊断一致率低。在临床实践中,不推荐使用226Hz探测音鼓室导抗测试的结果作为标准来判断婴幼儿中耳有无积液。     

根据鼓室积液物理特性处理伴腺样体肥大的分泌性中耳炎

目的 探讨根据鼓室积液物理特性区别处理伴发于腺样体肥大的分泌性中耳炎临床价值.方法 对2006年1月～2008年1月在我院手术的伴发于腺样体肥大的分泌性中耳炎患者按其鼓室积液物理特性进行区别处理.鼓室积液量多黏稠时,行鼓膜置管术;鼓室积液量少稀薄时,仅行鼓膜穿刺抽液.所有患者同时行腺样体切除术.结果 鼓膜置管组167例...     

鼓室封闭治疗复发性渗出性中耳炎

渗出性中耳炎是以鼓室积液及听力下降为主要特征的非化脓性中耳疾病.对难治性患者,临床多采用鼓室置管,反复鼓膜穿刺抽液,激光打孔等方法治疗,我科近年试用鼓膜穿刺加负压吸引加鼓室封闭的方法治疗难治性中耳炎2例,均取得较好的疗效,现报告如下.     

正常青年中耳共振频率的测定

正常青年中耳共振频率的测定王长明，王丽茵，吴桂欣，李丽，朱奕祺中耳系统的劲度因素和质量因素的病变均可改变其共振频率。劲度因素增大或质量因素减小（如听骨链固定等），中耳系统共振频率向高频侧移动；劲度因素减小或质量因素增大（如听骨链松弛或中断，鼓室成形术...     

鼓室积液对听力的影响：附41例报告

对４１例分泌性中耳炎患者的４６耳作纯音测听，然后行鼓膜穿刺抽液及咽鼓管吞咽吹气法治疗，并分别测试穿刺及通气后的听阈。结果表明治疗前后的听阈改变有高度显著性差异（Ｐ〈０．００１）。分析发现鼓室积液的听力无一致性。积液造成的听力损失以４、１、２ｋＨｚ者较重，积液对听力的影响与病程、液体性质与量无相关性。作者强调了穿刺后作连续通气治疗的意义。     

负压型鼓室导抗图诊断成人鼓室积液的研究

目的:探讨负压型鼓室导抗图对成人鼓室积液的诊断价值.方法:采用美国GSI-Tympstar Ⅱ型中耳分析仪,对所有疑似分泌性中耳炎的成人患者行声导抗检查,包括鼓室导抗图峰压、宽度、中耳共振频率及镫骨肌反射,选择其中为负压型鼓室导抗图的207耳行鼓膜穿刺,根据穿刺积液量将患耳分为无积液组(123耳)、少量积液组(45耳)及多量积液组(39耳),分别就3组患者的声导抗指标及同侧镫骨肌反射引出情况进行统计学分析.结果:无积液组的鼓室导抗图峰压、中耳共振频率与少量积液组和多量积液组之间的差异均有统计学意义(P<0.05或P<0.01);无积液组鼓室导抗图宽度与多量积液组之间的差异有统计学意义(P<0.01);3组间的同侧镫骨肌反射引出情况均差异有统计学意义(均P<0.01).结论:鼓室导抗图峰压、宽度,中耳共振频率结合同侧镫骨肌反射对判断成人负压型鼓室导抗图的鼓室有无积液具有诊断价值.     

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.     

The effect of middle ear effusions from children on in vitro ciliary activity

Summary In an attempt to clarify the effect of middle ear effusions (MEEs) on ciliary activity, the ciliary beat frequency (CBF) of nasal epithelium from normal subjects was determined following incubation in Hanks' solution containing effusions from pediatric otitis media with effusion. Both serous and mucoid types of effusions increased CBF 15 min after incubation. The mucoid type of effusion was then found to decrease CBF 6 h after incubation. Since the pH and osmotic pressure of the solution containing the effusions were within the physiological ranges for normal ciliary beating, our findings show that MEEs can influence CBF in vitro. Offprint requests to: Y. Sakakura     

Prostaglandin content in human middle ear effusions

Summary The concentrations of prostaglandins (PGs) were measured by a radioimmunoassay in human middle ear effusions (MEEs) obtained from patients with otitis media with effusions. Each sample of MEE was divided into two groups: serous effusions and mucoid ones. The main PG in both the serous and mucoid effusions was TXB₂ (375 and 857pg/ml, respectively), followed by PGE₂ (173 and 459pg/ml, respectively). Smaller quantities of PGD₂ (35 and 64 pg/ml, respectively), PGF_2a (139 and 183 pg/ml, respectively), and 6keto PGF_1a (129 and 201 pg/ml, respectively) were also found in the MEEs. The amounts of each PG in the mucoid effusions were 2 or 3 times higher than those found in the serous effusions, while protein concentrations and the profile of these PGs in the MEEs were almost the same in the mucoid and serous groups. These results suggest that PGs may play an important role as a mediator of the inflammatory responses in the pathogenesis of MEEs.     

Proinflammatory and immunoregulatory cytokines in the middle ear effusions

OBJECTIVE: The recognition of inflammatory mediators in middle ear effusions and their correlation with clinical parameters may allow better understanding of many complex events leading to development of permanent sequelae of otitis media and hopefully help to develop future interventions. The aim of the study was to evaluate the presence and level of proinflammatory interleukin (IL) 1beta, IL-6 and immunoregulatory IL-10 in the middle ear effusions, their mutual correlation and relationship with age, duration of the illness, number of episodes of acute otitis media, and presence of retraction pockets. METHODS: The study included 25 children (41 ears), who had been scheduled for myringotomy with the insertion of tympanostomy tubes due to otitis media with effusion. The interview (duration of the illness, number of episodes of acute otitis media), clinical and audiological examination was conducted according to the developed examination check list. Middle ear effusions (MEE) were collected aseptically, the samples centrifuged and supernatant frozen at a temperature of -80 degrees C. The IL-1beta, IL-6 and IL-10 were assayed using enzyme-linked immunosorbent assay (ELISA) kits incorporating monoclonal antibodies and the ETI system reader. The nonparametric Mann-Whitney U test was used for statistical analysis and Pearson's linear correlation coefficient was calculated. RESULTS: IL-1beta was detected in 80% of examined effusions, IL-6 in 78%, and IL-10 in 88%. There was a strong statistical correlation between IL-1beta and IL-6 concentrations (r=0.627, P=0.000), as well as IL-6 and IL-10 (r=0.66, P=0.000) No statistically significant correlation was found between levels of cytokines and clinical parameters. CONCLUSIONS: Proinflammatory and immunoregulatory cytokines participate in middle ear inflammatory response. The lack of direct correlation between IL-1beta and IL-10 may be responsible for chronic character of the disease. As no correlation between the levels of cytokines and clinical parameters was found it seems that the time of duration of inflammation rather than its intensity measured by levels of cytokines is the main factor in development of middle ear mucosa pathology.     

Ciliary beat frequency of nasal and middle ear mucosa in children with otitis media with effusion

Impaired mucociliary function of respiratory tract mucosa is associated with secretory otitis media in some well recognized syndromes. Ciliary activity per se may now be assessed directly by determination of ciliary beat frequency by a photoelectric technique.^1,2 49 children with otitis media with effusion undergoing surgical treatment were studied. Middle ear mucosa and nasal epithelial cells were obtained by biopsy and cytological brushings respectively at the time of surgery (myringotomy ± grommet insertion under general anaesthesia). From these samples mean nasal ciliary beat frequency was 11.0 Hz and mean middle ear ciliary beat frequency was 11.2 Hz. A positive correlation exists between mean ciliary beat frequency of nasal and middle ear samples from individual patients. A comparison of mean ciliary beat frequency between children who were effusion positive and effusion negative at the time of surgery revealed no statistically significant difference. In addition, no difference existed between those children with recurrent otitis media with effusion and newly presenting cases. No prima facie evidence exists of impaired ciliary function in this population of children with otitis media with effusion.     

Determination of lipid A in human middle ear effusions with the competitive ELISA technique

Summary Lipid A is a covalently bound component of gram-negative bacterial lipopolysaccharides and is the biologically active component in endotoxin. In order to detect and quantitate lipid A in middle ear effusions (MEE) from patients with otitis media with effusion (OME), antisera against lipid A were produced in mice by repeated immunization with conjugates using lipid A from Salmonella minnesota Re595 and bovine serum albumin. As a result, a competitive enzyme-linked immunosorbent assay (ELISA) was developed that was specific for lipid A. From the ELISA results, 10 out of 15 samples from the serous type MEE (mean, 13.57±2.17 g/ml) and 5 out of 6 from the mucoid type MEE (17.73±4.34 g/ml) were positive. These findings indicate that lipid A may contribute to the pathogenesis of both types of human OME.     

Vascular permeability of the middle ear mucosa in otitis media with effusion

Summary Vascular permeability (VP) of the middle ear mucosa (MEM) in chronic otitis media with effusion (OME) was estimated in both pediatric and adult patients by calculating the middle ear effusion (MEE) to serum concentration ratios of albumin and of four protease inhibitors: 1-antitrypsin (1-AT), 1-antichymotrypsin (1-X), inter--trypsin inhibitor (I--I) and 2-macroglobulin (2-M). The levels of albumin and 1-AT in MEE were higher while those of I--I and 2-M were lower than their serum levels in both adult serous and pediatric mucoid groups. There was a negative correlation between molecular weight and the mean value of the ratio (MEE/serum) of the four inhibitors in both serous (r=–0.989) and mucoid (r=–0.924) groups. Vascular permeability of the MEM seems to be variable in both serous and mucoid groups during middle ear inflammation. Selective leakage of proteins by molecular weight appears to occur in MEM. Our findings further indicate that a high level of the high-molecular-weight inhibitor 2-M in MEE may be a significant index reflecting the remarkably enhanced VP of the MEM.     

Glucocorticoids reduce nitric oxide concentration in middle ear effusion from lipopolysaccharide induced otitis media

Objective

Otitis media with effusion (OME) is a common childhood disease that is characterized by an accumulation of fluid in the middle ear. Chronic OME can also lead to sensorineural hearing loss (SNHL). Nitric oxide (NO), an inflammatory mediator (IM) of OME, is a free radical known to regulate cell proliferation, cell death, and angiogenesis. Previous studies have shown that nitric oxide may cause SNHL through outer hair cell (OHC) cytotoxicity. This experiment was designed to determine whether glucocorticoids, dexamethasone, fluticasone propionate, or rimexolone, can reduce the concentration of NO in middle ear effusion (MEE).

Methods

Fifty-three chinchillas were divided into 7 groups, vehicle vs. each glucocorticoid at 0.1% and 1.0% concentrations. Due to anesthesia complications, N ranged from 6 to 9 per group. Two hundred microlitres of each test article was injected into the bullae of each animal. Two hours later, lipopolysaccharide (LPS) (0.3 mg in solution) was added. Test articles were re-administered at 24 and 48 h post-LPS induction. After 96 h, animals were euthanized and the MEE was collected.

Results

All three glucocorticoids numerically reduced NO concentration in the middle ear when administered at 0.1%, but only FP showed a significant reduction. At 1.0% concentrations, all 3 steroids significantly reduced NO concentration.

Conclusion

This study suggests that glucocorticoid treatment reduces NO concentration in the MEE and may protect the ear from the SNHL caused by NO.     

Effect of bacterial endotoxin and middle ear effusion on ciliary activity: implications for otitis media

OBJECTIVES/HYPOTHESIS: Otitis media with effusion (OME) is the most common cause of childhood deafness. The pathogenesis is not fully understood, especially the reasons for failure of mucociliary clearance of the middle ear. It is not clear whether the cilia function normally in the middle ear and eustachian tube in the chronic phase of otitis media with effusion. However, impaired ciliary function in primary ciliary dyskinesia is known to be frequently associated with the development of otitis media with effusion. We hypothesized that endotoxin or the bacterial products in middle ear fluid in otitis media with effusion would adversely affect ciliary activity, thereby contributing to the pathogenesis of the disease. STUDY DESIGN: Laboratory-based study of human ciliary activity with reference to otitis media with effusion. METHODS: We have studied the activity of human adenoidal cilia under various conditions. Ciliary activity in the presence of Haemophilus influenzae endotoxin additions (at varying concentrations) to cultured adenoidal explants has been measured. In addition, ciliary activity of these explants was also observed after addition of middle ear effusion aspirated from patients. RESULTS: We have shown that endotoxin in concentrations far in excess of those found in the middle ear with chronic otitis media with effusion had no effect on ciliary activity. Furthermore, ciliary activity was completely unaffected by the presence of middle ear effusion. CONCLUSION: There is no evidence that ciliary activity is reduced by the constituents of middle ear fluid in chronic otitis media with effusion.     

Results of middle ear ventilation with ‘Mangat’ T-tubes

Tympanostomy tube placement has been shown to be an effective treatment for recurrent acute otitis media and chronic otitis media with effusion. The Senior author, (K.S. Mangat), considered stiffness and the longer inner limbs of the Goode (Xomed) or Treace (Treace Medical) T-tubes as important factors in the high incidence of complications, and used smaller soft silicone, Mangat-tube (Xomed) with shorter inner limbs. A prospective study was undertaken over a five year period (July 1987–July 1992) which was a continuation of a previous retrospective study of Goode and Treace T-tubes (Mangat, K.S, Morrison, G.A.J., and Ganiwalla, T.M. (1993) Int. J. Pediatr. Otorhinolaryngol. 25, 119–125). 322 Mangat tubes (M-tubes) were inserted in 191 patients with persistent otitis media with effusion. The peak ages for insertion were between 4 and 6 years. Spontaneous extrusion occurred in 240 ears (66.5%; 154 patients) at a mean time of 29.3 months. Of these, there were 60 perforations at three months follow-up (18.6%) which fell to 31 perforations after six months (9.6%). Surgical extraction of the M-tube was necessary in 82 ears (22.7%; 50 patients) following persistent otorrhoea or resolution of the condition. Otorrhoea, requiring treatment, was noted in 36 ears (11%). No association was found between the occurrence of infection and the incidence of perforation persisting after a year. There was a higher incidence of persistent perforation in those requiring surgical extraction. The overall persistent perforation rate of only 9.6% would appear to be less than that experienced with Goode or Treace T-tubes.     

Magnesium levels in middle ear fluids and sera in otitis media with effusion

Summary Middle ear fluids (MEE) and matched sera (S) were obtained from 50 patients with serous otitis media and magnesium levels were measured to determine if magnesium concentration was distinctly varied in otitis media with effusion (OME). The MEE/S ratio was considerably raised along with transient sensory hearing loss in chronic OME when compared with acute OME. The higher magnesium level found in the MEE implies that it is probably produced locally by the middle ear mucosa and may contribute to the hearing loss found. We also regard the MEE/S ratio as a prognostic factor in OME. Correspondence to: W. L. Yue