中耳细菌感染对内耳及机体免疫功能长期影响的？…

目的 探讨中耳细菌感染后内耳热休克反应是否会长期存在，及其对内耳功能的潜在影响。方法 ６０只ＢＡＬＢ－ｃ鼠随机分为肺炎克雷白杆菌、金黄色葡萄球菌（简称金葡菌）、绿脓杆菌、大肠杆菌、变形杆菌和生理盐水对照６个组，每组１０只。中耳注射致病菌１３５ｄ后测试畸变产物耳声发射并取材进行光镜与电镜观察，检测内耳热休克蛋白（ＨＳＰ）７０相关表位分子的表达，行单个核细胞因子κ－Ｂｐ６５和抗肺炎克雷白杆菌抗体、抗膜     

实验性急性中耳细菌感染诱发的热休克反应

目的 探讨细菌抗原和内耳抗原之间的联系及热休克反应对其抗原的影响。方法 用抗哺乳类热休克蛋白（ｂｅａｔ ｓｈｏｃｋ ｐｒｏｔｅｉｎ，ｈｓｐ）７０抗体识别绿脓杆菌、变形杆菌、大肠杆菌、金黄色葡萄球菌和肺炎克雷白杆菌抗原，进行免疫转印分析，测试正常豚鼠膜迷路中ｈｓｐ７０的表达水平。用肺炎克雷白杆菌制作急性中耳感染动物模型，观察细菌的内耳与哺乳类ｈｓｐ７０家族，正常豚鼠膜迷路表达ｈｓｐ７０水平极低。肺炎     

自身免疫性感音神经性聋血清抗膜迷路蛋白抗体的检测

采用改良免疫转印法分析了拟诊为自身免疫性感音神经性听力减退患者体内抗膜迷路蛋白抗体，并将该法与常规法比较，发现用该法在患者血清中最多可检出５条强阳性带（含６８０００），阳性率为７２％（１８／２５），显著高于常规法（４０％）。还在部分患者体内检出了抗肺炎克雷白杆菌膜蛋白抗体（７／９）。     

自身免疫性感音神经性聋血清抗膜迷路蛋白抗体的检测

采用改良免疫转印法分析了拟诊为自身免疫性感音神经性听力减退患者休内抗膜迷路蛋白抗体，并将该法与常规法比较，发现用该法在患者血清中最多可检出５条强阳性（含６８０００），阳性率为７２％（１８／２５），显著高于常规法（４０％）。还在部分患者体内检出了抗肺炎克雷白杆菌膜蛋白抗体（７／９）。     

核转录因子κ-Bp65在中耳胆脂瘤上皮中的表达和意义

目的检测核转录因子-κBp65（nuclear factor kappa Bp65,NF-κBp65）在中耳胆脂瘤上皮中的表达和活化,探讨其在中耳胆脂瘤发病机制中的可能作用。方法采用免疫组织化学SP法检测30例中耳胆脂瘤组织标本与15例正常外耳道皮肤标本中NF-κBp65蛋白的表达。结果NF-κBp65蛋白阳性表达定位于上皮细胞核。NF-κBp65蛋白在中耳胆脂瘤上皮组织中阳性表达率为63.3%,明显高于正常外耳道皮肤组的20.0%（P〈0.01）。结论NF-κBp65蛋白在中耳胆脂瘤上皮的异常表达可能在胆脂瘤的发生、发展过程中起重要作用。胆脂瘤上皮中NF-κBp65的活化可能参与了胆脂瘤上皮细胞过度增殖机制。     

豚鼠膜迷路蛋白抗原性分析

应用电泳吸附斑点免疫检测法和改良免疫转印法，发现粗制的豚鼠膜迷路蛋白是一种极为复杂的抗原，十二烷基磺酸钠。聚丙烯酰胺凝胶电泳至少可将其分出２２种成分。６８ｋＤ含有４种不同等电点的成分。Ｗｅｓｔｅｒｎｂｌｏｔｔｉｎｇ法分析可以检出ｌｌ条阳性反应带，包括６８ｋＤ、６０ｋＤ和３２ｋＤ，条带之间存在交叉抗原性，膜迷路蛋白和听神经、耳蜗核及肾脏的蛋白成分之间有交叉抗原性，主要位于９８ｋＤ、６８ｋＤ及２７．４ｋＤ，免疫组织化学研究发现抗膜迷路蛋白抗血清可以和内耳广泛的组织结构发生反应，主要部位是：血管纹的细胞膜和细胞间质及螺旋凸，Ｃｏｒｔｉ器的内外毛细胞及支持细胞的胞膜和胞浆，盖膜以及螺旋神经节的细胞膜。还初步发现抗膜迷路蛋白抗血清可以和克雷白杆菌膜蛋白发生交叉反应。     

中耳细菌感染诱导的急性期HSP-70相关反应的免疫组织化学研究

探讨中耳细菌感染急性期时 ,哺乳动物中、内耳热休克反应的部位 ,以及中耳细菌感染诱生的热休克蛋白是否可能引发内耳自身免疫损伤。运用中耳注射肺炎克雷伯杆菌制成豚鼠中耳急性感染动物模型 ,分别于接种后第 1、3、5、7天处死动物取材。应用免疫组化技术 ,研究了中耳粘膜和耳蜗表达热休克蛋白 70 (HSP- 70 )的部位。结果表明 :正常状态下 ,中耳粘膜表层的上皮细胞和内耳膜迷路血管纹、螺旋韧带、Corti氏器均有弱的阳性反应 ,感染应激后 ,上述同样部位均有强的阳性显色。不同取材时段显示的阳性位置无差异。说明在中耳急性细菌感染期 ,中耳粘膜和内耳组织均表达了同源 HSP- 70蛋白分子 ,这些同源 HSP- 70为引发内耳自身免疫损伤提供了物质基础。     

中耳细菌感染诱导的急性期HSP—70相关反应的免疫组织化学研究

探讨中耳细菌感染急性期时,哺乳动物中、内耳热休克反应的部位,以及中耳细菌感染诱生的热休克蛋白是否可能引发内耳自身免疫损伤。运用中耳注射肺炎克雷伯杆菌制成豚鼠中耳急性感染动物模型,分别于接种后第1、3、5、7天处死动物取材。应用免疫组化技术,研究了中耳粘膜和耳蜗表达热休克蛋白70（HSP－70）的部位。结果表明：正常状态下,中耳粘膜表层的上皮细胞和内耳膜迷路血管纹、螺旋韧带、Corti氏器均有弱的阳性反应,感染应激后,上述同样部位均有强的阳性显色。不同取材时段显示的阳性位置无差异。说明在中耳急性细菌感染期,中耳粘膜和内耳组织均表达了同源HSP－70蛋白分子,这些同源HSP－70为引发内耳自身免疫损伤提供了物质基础。     

两种不同细菌所致急性中耳炎对内耳损伤的差异

目的研究两种毒力不同的细菌导致的急性中耳炎对内耳超微结构损伤的差异.方法豚鼠麻醉后,一组在无菌条件下于右耳经鼓膜注射1×108·L-1的绿脓杆菌液100μL,左耳作正常对照;另一组同法注射金葡菌液.三天后常规处理,透射、扫描电镜观察.结果造模后三天,绿脓杆菌感染组及金葡菌感染组基底膜、血管纹均可见细胞损伤、细胞器变性,绿脓杆菌感染组内耳超微结构的改变明显重于金葡菌感染组.结论急性中耳炎早期即可有内耳的形态学改变,绿脓杆菌引起的急性化脓性中耳炎可能会导致严重感音神经性聋.     

慢性化脓性中耳炎的细菌特性及治疗原则

鉴于慢性化脓性中耳炎菌群时常变化,治疗中应了解细菌特性及药敏改变。通常认为常见需氧菌有绿脓杆菌(42%)、金黄色葡萄球菌(39.8%)、普通变形杆菌(33.2%)、肺炎克雷白氏杆菌(15%)及大肠杆菌(8.3%);厌氧菌有脆弱类杆菌、消化链球菌及丙酸杆菌。革兰氏阴性杆菌通常对红霉素(58.8%)、四环素(47.1%)、卡那霉素(41.2%)、氯霉素(35.3%)等较敏感,另对氟嗪酸。哌拉西林,     

中耳力学研究

中耳炎是一个古老话题,围绕如何重建受损鼓膜与听骨链的相关研究一直经久不衰.耳外科医师关注两个主要问题:外中耳病理变化如何影响声音传递,鼓膜听骨链病变性质、范围与纯音听阈关系如何?如何通过手术去除病变组织的同时,使得重建后的外中耳结构、声学与力学特性近似正常,从而提高听力?众多耳科医师已经认识到鼓耳道角变钝会导致术后传导性听力损失,锤骨柄完整、镫骨完整的病例术后气骨导差小,尽可能保持中耳正常结构是减小鼓室成形术后气骨导差的重要因素.     

中耳力学研究

本文以研究方法为维度对中耳力学研究进行了系统全面介绍,包括物理实验检测,如声导抗检测、激光多普勒测振仪,频闪成像测量仪,重力显微镜,可以实现更大维度、更小尺度、复杂的力学探测;有限元模型分析经历了逐渐发展和成熟的历程,目前不仅用于研究中耳生理、病理、手术、听觉植入假体,还深入到结构更加精细复杂的内耳力学领域。实验法和模型研究法两者从一开始就具有互补的关系。     

Inner ear depression after middle ear interventions

BACKGROUND: Any type of otosurgical procedure involves the risk of inner ear damage. As middle ear surgery is also performed for functional reasons this risk should be taken into consideration. The aim of this study was to analyse the frequency and the nature of sensorineural hearing loss following chronic ear surgery. PATIENTS: A total of 3989 middle ear cases operated on between 1991 and February 1999 at the Department of Otorhinolaryngology, Head and Neck Surgery, University of Würzburg, Germany were studied retrospectively: 781 type I tympanoplasties, 2408 type III tympanoplasties and 800 cases of stapes surgery. The pre- and the postoperative audiograms in the frequency range between 500 and 8000 Hz were analysed and correlated to the different intraoperative findings. RESULTS: Sensorineural hearing loss occurred in a total of 1.3% of 2224 patients with normal preoperative bone conduction thresholds: 0.2% became deaf, 0.8% acquired a high tone loss at 4 kHz and in 0.3% patients also 2 kHz was affected. None of the documented intraoperative complications such as bleeding, unexpected opening of a semicircular canal, extensive manipulation at the ossicular chain or a gusher phenoma showed a relevant effect on postoperative bone conduction thresholds. The incidence of high tone loss was not increased in cases of extensive drilling of the temporal bone. An unexpected opening of the vestibulum led to a small, but statistically significant change in postoperative bone conduction thresholds. CONCLUSIONS: Our results demonstrated that the risk for sensorineural hearing loss caused by middle ear surgery is low. None of the analysed factors seems to be a relevant prognostic risk factor for postoperative inner ear depression.     

Therapy of ear hematoma and ear seroma

Conservative techniques for the treatment of auricular haematomas are unsuccessful. We discuss different operative methods and compare our results with these techniques. In our opinion the method described by Kelleher is a simple and reliable method for the treatment of auricular haematoma and seroma. After incision and evacuation of the fluid, tie-over sutures over wet sponges achieve efficient obliteration of the subperichondrial space. The most important advantages of the technique are that no resection of cartilage is necessary, the obliteration of the subperichondral space is stable, the cosmetic results are good, and the complication rate is low.     

Effects of inflammatory changes in the middle ear mucosa on middle ear total pressure

Conclusions. Inflammation of the middle ear mucosa leads to inhibition of transmucosal carbon dioxide (CO₂) diffusion. Furthermore, CO₂ diffusion is inhibited more severely in ears with a histologically higher grade of inflammation. Objectives. To investigate the effect of inflammatory changes in the middle ear mucosa on transmucosal gas exchange, and the relationship between the histologic inflammation grade of the middle ear mucosa and the middle ear total pressure (METP). Materials and methods. Twenty-six rabbits were used for this study. Changes in the METP and the oxygen partial pressure in the middle ear (PmO₂) were measured in the otitis media group and the untreated group, and were compared between the two groups. Inflammatory changes in the middle ear mucosa were classified into four grades histologically, and the relationship between the histologic inflammatory grade and the maximum METP was examined. Results. The maximum METP in the otitis media group was significantly decreased compared with the untreated group (p<0.05), but there was no difference between the two groups in the rate of decrease of the PmO₂. Furthermore, the maximum METP in grade III inflammation was significantly decreased compared with that in grade II inflammation (p<0.05).