鼓室硬化患者鼓室成形术后听力效果评估

目的 探讨鼓室硬化患者鼓室成形术后的听力康复效果及其影响因素.方法 回顾性分析2014-2018年于北京大学第三医院行鼓室成形术的69例鼓室硬化患者.采用以下两种分组方法:1)按照病变类型分为2组:单纯型组与胆脂瘤及其他病变组;2)按照病变范围分为2组:镫骨未受累组及镫骨受累组.观察术后纯音听阈(PTA)及骨气导间距(...     

鼓室成形术治疗不同类型鼓室硬化患者的近期疗效分析

目的探讨鼓室成形术治疗不同类型鼓室硬化患者的近期疗效。方法回顾性分析2008年2月至2011年2月间有完整资料且随访半年以上、经鼓室成形术治疗的33例鼓室硬化患者(I型8例,II型9例,III型2例,IV型14例)的临床资料,其中8例行鼓室探查+鼓膜成形术,25例行开放式乳突根治+鼓室成形术,以言语频率气导平均听力改善15dB以上或达应用听力水平为手术成功标准,评估其疗效。结果 33例患者术前言语频率气导平均听阈为54.09±9.76dB HL;术后半年随访时平均听阈为38.85±8.42dB HL,总手术成功率为63.64%(21/33),其中鼓室探查+鼓膜成形术8例中4例(50%)手术成功,开放式乳突根治+鼓室成形术25例中17例(68%)手术成功。结论鼓室成形术是治疗鼓室硬化的有效手术方法,开放式乳突根治+鼓室成形术能有效清除听骨链周围不同范围的硬化灶。     

鼓室硬化的手术疗效观察

目的:观察鼓室硬化手术采用综合技术的疗效。方法:回顾性分析151例(167耳)鼓室硬化(不含单纯鼓膜钙化)患者的临床资料。167耳均清除病灶并按需采用综合技术:①探孔开放上鼓室、乳突腔等;②自体骨片盾板修复,或碎骨填塞乳突腔;③听骨处理分为保持听骨链完整和听骨链重建;④可吸收膜片(透明质酸或聚二氧杂环乙酮)防再粘连;⑤鼓索神经弹压听骨;⑥铒-YAG激光或小凿清除面神经管骨质增生。术后1个月内测听力,出院3个月后复查1次,以后6个月~1年随访1次,以最后1次为随访结果(取0.5、1.0、2.0 kHz HL语频均数)。结果:167耳术前、术后气骨导差(ABG)分别为(39.74±12.54)dB和(20.68±11.80)dB,P<0.01。成功71耳(42.5%),有效48耳(28.7%),总有效率为71.3%(119耳)。167耳随访3~60个月,平均(11.01±10.24)个月,随访的ABG为(20.67±13.52)dB,与术前比较,P<0.01;与术后比较,P>0.05。随访12个月以上者96耳,ABG为(21.94±11.16)dB,与167耳随访结果比较,P>0.05。结论:应用综合技术能促进术后听力改善,并维持远期疗效。三骨全固定仍是治疗难点,对镫骨切除术应慎重对待。     

鼓室硬化的发病机制

鼓室硬化是鼓膜固有层或中耳黏膜下层的结缔组织发生透明样变性和钙质沉着,少数可发生骨化.鼓室硬化可导致进行性传导性聋,手术治疗效果不理想,是当前的耳科难题之一.鼓室硬化的发病机制尚不清楚,与感染、氧自由基、血钙代谢、蛋白分子和遗传等因素有关.本文对鼓室硬化发病机制的最新研究进展做一综述.     

鼓室硬化的发病机制

鼓室硬化是鼓膜固有层或中耳黏膜下层的结缔组织发生透明样变性和钙质沉着,少数可发生骨化。鼓室硬化可导致进行性传导性聋,手术治疗效果不理想,是当前的耳科难题之一。鼓室硬化的发病机制尚不清楚,与感染、氧自由基、血钙代谢、蛋白分子和遗传等因素有关。本文对鼓室硬化发病机制的最新研究进展做一综述。     

鼓室硬化的发病机制

鼓室硬化是鼓膜固有层或中耳黏膜下层的结缔组织发生透明样变性和钙质沉着,少数可发生骨化.鼓室硬化可导致进行性传导性聋,手术治疗效果不理想,是当前的耳科难题之一.鼓室硬化的发病机制尚不清楚,与感染、氧自由基、血钙代谢、蛋白分子和遗传等因素有关.本文对鼓室硬化发病机制的最新研究进展做一综述.     

颞骨轴位HRCT对鼓室硬化的诊断价值

目的通过对分析鼓室硬化颞骨轴位HRCT表现,评价颞骨轴位HRCT对鼓室硬化的诊断价值。方法回顾性分析20例(共20耳)经手术证实的鼓室硬化患者的颞骨轴位HRCT。结果鼓室内软组织密度影6耳,鼓室内钙化及软组织影13耳,单纯鼓膜钙化影1耳,鼓膜增厚16耳。硬化灶位于听小骨周围的19耳,其中硬化灶覆盖蜗窗的2耳。结论颞骨轴位HRCT可以显示鼓膜及鼓室内的硬化灶及病变部位,结合临床鼓膜像,进行综合分析,对鼓室硬化的诊断有指导意义。     

HRCT对鼓室硬化术前诊断的价值

目的探讨高分辨率CT(HRCT)对鼓室硬化术前诊断的价值。方法将确诊的62例鼓室硬化患者的HRCT表现与术中所见实际情况对比。结果 33例HRCT表现为鼓窦及入口、上中鼓室的异常硬化灶或密度不均的高密度影,听骨链结构紊乱或被硬化灶包裹为主,10例仅表现为穿孔鼓膜的增厚钙化,鼓室内未发现钙化灶,这43例HRCT表现与术中探查情况和术前诊断一致;8例诊断为其他疾病(误诊),其中胆脂瘤合并硬化4例,粘连性中耳炎合并硬化3例,慢性分泌性中耳炎合并硬化1例,影像学表现均以软组织影或听骨链及骨质破坏为主;漏诊11例,其中9例因传导性聋行手术探查,2例为单纯鼓膜钙化,这11例HRCT均无明显异常。结论颞骨HRCT对明确鼓室硬化的术前诊断及病变范围很有价值的同时也存在一定局限性。     

鼓室硬化的治疗

鼓室硬化是指中耳黏膜下层或鼓膜固有层中弹性纤维透明样变性,是中耳黏膜慢性炎症或反复急性炎症的终末反应。早在1869年Troltsch首先描述了该病,其病因不清,有研究发现可能与遗传、动脉粥样硬化、高钙血症等有关。鼓室硬化的发病机制也不甚清楚,但有一点是达成共识的,即鼓室硬     

Comparison of free radicals and antioxidant enzymes in chronic otitis media with and without tympanosclerosis

Objective/Hypothesis The pathogenesis of tympanosclerosis is unclear. The study was performed to investigate the role of nitric oxide, free oxygen radicals, and antioxidants in development of tympanosclerosis in patients with chronic otitis media. Study Design A prospective study in patients with nasal polyps. Methods Sixty‐five patients who underwent tympanoplasty or tympanoplasty together with mastoidectomy were included in the study. Preoperative venous blood samples were drawn, and serum sodium, potassium, calcium, alkaline phosphatase, inorganic phosphorus, parathormone, and calcitonin levels were measured. The patients who had tympanosclerotic plaques on tympanic membrane or middle ear mucosa or near the ossicular chain or mastoid bone were designated as group 1 (n = 34), and the remaining patients as group 2 (n = 31). Intraoperatively, specimens were obtained from the middle ear mucosa and tympanic membrane to measure nitric oxide and malondialdehyde levels. In addition, plasma malondialdehyde levels and erythrocyte superoxide dismutase and catalase activity were determined. Results All patients had similar demographic features and serum electrolyte and hormone levels. Nitric oxide and malondialdehyde levels of the specimens obtained from the middle ear mucosa (P = .001) and tympanic membrane (P = .01) and, in parallel to this, the plasma malondialdehyde activity level were higher in group 1 than in group 2. Moreover, group 2 had significantly lower erythrocyte catalase activity levels (P = .001) compared with group 1, whereas such a significant difference was not present for superoxide dismutase activity levels (P > .05). Conclusion The study results suggest that nitric oxide, free oxygen radicals, and catalase may have a role in the development of tympanosclerosis in patients with chronic otitis media.     

Middle ear catalase distribution in an animal model of otitis media

Increasing evidence implicates free radicals in the pathogenesis of inflammatory disease, including otitis media. The anti-oxidant enzymes catalase, glutathione peroxidase and superoxide dismutase protect tissues from the destructive effects of free radicals. Our previous work has shown depressed levels of superoxide dismutase in the infected middle ears of a guinea pig model of otitis media in comparison with normal control ears. We studied the distribution and relative abundance of catalase in the middle ear of this animal model in an effort to elucidate the role free radicals play in the pathogenesis of otitis media. Catalase distribution was mapped immunohistochemically in the middle ears of guinea pigs with induced streptococcus otitis media, and compared with normal control ears. In the control ears, catalase was localized to the epithelium of the middle ear mucosa, with scant distribution in the submucosa. The infected ears demonstrated inflammatory cell invasion with hyperemia and submucosal edema. Catalase was localized to the epithelium and had scant distribution in the submucosa. This distribution was similar to that found previously with superoxide dismutase. Enzyme-linked immunosorbent assay of catalase demonstrated a mean value of 1.00 ± 0.06 g/mg protein in the control ears, and 1.06 ± 0.12 g/mg in the infected ears, but these two values were not statistically different.     

Superoxide dismutase in an animal model of otitis media

Cu, Zn superoxide dismutase (SOD) is a metalloprotein that catalyzes the dismutation of the superoxide anion into O₂ ^– and H₂0₂, and therefore functions to maintain a low intracellular concentration of an otherwise toxic metabolite of oxygen. SOD protects living tissue from the destructive effects of free radicals. Increasing evidence implicates free radicals, including the superoxide radical (O₂ ^–), in the pathogenesis of disease, including otitis media. In an effort to elucidate the role free radicals play in the pathogenesis of otitis media, SOD was localized immunocytochemically to determine its cellular distribution in specimens of guinea pig middle ear. In normal ears, SOD was found concentrated in the epithelium of the middle ear mucosa. Low quantities were characteristic of connective tissue, bone, and cartilage. In streptococcus-infected ears, SOD localized similarly, concentrating in the epithelium. The infected ears had extensive submucosal edema which stained poorly and appeared to have less SOD than did normal ears. This was confirmed by an assay using laser densitometry of Western blots to quantify the amount of SOD in the mucosa of normal versus infected middle ears. This demonstrated a value of SOD in normal mucosa of 1.77 ± 0.48 g/mg of protein compared with 1.02 ± 0.28 g/mg in the infected mucosa. The two groups were significantly different at P < 0.05. These findings are discussed, and suggestions for future experimentation addressed.Adapted from a presentation at the October 1993 annual meeting of the American Academy of Otolaryngology —Head and Neck Surgery, Minneapolis, Minnesota, USA     

超氧化物歧化酶及白细胞因子在分泌性中耳炎中的表达

目的 :探讨超氧化物歧化酶 (SOD)和白细胞介素 - 6 (IL - 6 )、白细胞介素 - 8(IL - 8)、肿瘤坏死因子 -α(TNF-α)在分泌性中耳炎发生和转归中的作用。方法 :检测 74例 (90耳 )分泌性中耳炎患者 (中耳炎组 )血浆和中耳积液中 SOD、IL- 6、IL- 8及 TNF- α,并以 30例健康人血浆作对照。结果 :中耳炎组 SOD、IL- 6、IL- 8及 TNF- α在中耳积液中阳性表达率分别为 88.9%、86 .8%、81.5 %和 74 .6 % ;其血浆含量均较对照组高 (P <0 .0 5 )。中耳炎组中耳积液的含量均较血浆中高 (P <0 .0 1)。病程短者 IL- 6和 IL- 8含量较病程长者高 (P <0 .0 1、 P <0 .0 5 ) ;病程长者 SOD及 TNF- α含量较病程短者高 (P <0 .0 1、 P <0 .0 5 )。浆液性积液者 IL- 6和 IL- 8含量较粘液性积液者高 (P <0 .0 1、 P <0 .0 5 ) ;粘液性积液者 SOD及 TNF-α含量较浆液性积液者高 (P <0 .0 1、 P <0 .0 5 )。 SOD含量与 TNF-α含量正相关 (r =0 .5 87,P <0 .0 1)。结论 :IL - 6和 IL - 8在分泌性中耳炎发病早期参与机体的防御反应 ,促进浆液性中耳积液产生 ;SOD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     

鼻息肉组织和血清中SOD、MDA的测定及其意义

目的测定鼻息肉病人鼻息肉组织和血清中超氧化物歧化酶(superoxidedismutase,SOD)活性、丙二醛(malondialdehyde,MDA)含量的变化并探讨其意义。方法通过生物化学方法分别测定30例鼻息肉病人鼻息肉组织和血清中SOD的活性与MDA含量,以20例鼻中隔偏曲病人的下鼻甲黏膜和血清作为对照组。结果①实验组SOD活性显著低于对照组(P<0.01)。②实验组MDA含量显著高于对照组(P<0.01)。结论①鼻息肉病人清除自由基能力下降,脂质过氧化反应活跃。②提示自由基代谢紊乱为鼻息肉的发病机制之一。     

豚鼠慢性化脓性中耳炎鼓室硬化模型

目的 研究建立慢性化脓性中耳炎鼓室硬化动物模型豚鼠的方法,为慢性化脓性中耳炎鼓室硬化的动物实验研究提供一种有用的动物模型.方法 采用小鼠腹腔连续传代3次增强毒力的金黄色葡萄球菌,采取反复中耳腔注射的方法,制备豚鼠慢性化脓性中耳炎动物模型,了解化脓性中耳炎对听阈的影响及是否导致鼓室硬化.结果 将钙化斑及局部骨化作为鼓室硬化的标志,接种细菌后1周就可观察到中耳粘连的出现,接种后2周出现钙化斑等鼓室硬化灶,听力较对照耳明显下降.观察到硬化灶最常见的部分是下鼓室,其次是鼓室上隐窝、上鼓室、鼓膜、听骨链间隙和咽鼓管鼓口.结论 豚鼠慢性化脓性中耳炎鼓室硬化动物模型病理变化与人慢性化脓性中耳炎鼓室硬化类似,是研究慢性化脓性中耳炎鼓室硬化较好的动物模型.     

阻塞性睡眠呼吸暂停综合征患者自由基损伤与高血压的关系

目的：探讨超氧化物岐化酶SOD（superoxide dismutase）和丙二醛MDA（malondialdehyde）的改变与阻塞性睡眠呼吸暂停综合征合并高血压患者的相关性。方法：分别用黄嘌呤氧化酶法和硫代巴比妥酸法分检测OSAHS患者和对照组的SOD和MDA水平,比较组间差异和OSAHS 患者与合并高血压的相关性。结果：伴和不伴高血压的OSAHS患者血清SOD降低,MDA升高。SOD/MDA比值在OSAHS合并高血压的患者中明显降低,OSAHS合并高血压患者血清中SOD/MDA的比值分别与呼吸暂停低通气指数、呼吸障碍最长时间负相关,与最低血氧饱和度呈正相关。结论：SOD/MDA的比例失调可能在OSAHS患者合并高血压的发病中起着重要作用。     

Tympanoplasty with and without mastoidectomy for non-cholesteatomatous chronic otitis media

Objectives: Cases of non-cholesteatomatous chronic otits media (COM) were reviewed to determine whether mastoidectomy is helpful when combined with tympanoplasty for these conditions. Study design: A retrospective analysis of 251 ears with non-cholesteatomatous COM operated on by one surgeon (Y.M.) in an 11-year period was conducted. Methods: Patients in group A (n = 147) were treated by tympanoplasty with mastoidectomy. Patients in group B (n = 104) were operated on without mastoidectomy. Results: Graft success rates were 90.5% in group A and 93.3% in group B. There was no statistically significant difference. Graft success rates of discharging ears were 90.0% in group A and 85.7% in group B. Graft success rates of dry ears were 90.7% in group A and 94.4% in group B. There was no statistically significant difference between discharging ears and dry ears. The rates of the postoperative air–bone gap within 20dB were 81.6% in group A and 90.4% in group B, without a statistically significant difference. Conclusions: Mastoidectomy is not helpful in tympanoplasty for non-cholesteatomatous COM, even if the ear is discharging. Received: 8 February 2000 / Accepted: 12 October 2000     

Development of tympanosclerosis in children with otitis media with effusion and ventilation tubes

Ventilation tube (VT) insertion is an accepted treatment for chronic otitis media with effusion (OME) in children. One hundred and eighty five children with bilateral OME were treated by unilateral myringotomy and VT insertion with no treatment to the contralateral ear. During a 5 year follow-up 95 of the children required only one VT but the remainer required more than one but always treatment was carried out to the same ear. The rate of development of tympanosclerosis was measured and scored. After 2-3 years the extent of the sclerotic changes stabilised and the rate of development reached 37-39 per cent in ears receiving only one VT, compared with 47-49 per cent in ears treated by more than one tube. The extent of the changes was no different whether or not one or more than one tube had been inserted. There was no overall evidence of resolution of sclerotic change with time.     

Expression of C-type lectin receptor mRNA in otitis media with effusion and chronic otitis media with and without cholesteatoma

Background & objectivesC-type lectin receptors (CLRs) are a family of pattern recognition receptors (PRPs). The expression of CLRs has been analyzed in other diseases but has not yet been compared in patients with otitis media with effusion (OME), chronic otitis media (COM) and COM with cholesteatoma (Chole OM). This study therefore evaluated the levels of expression of mRNAs encoding Dectin-1, MR1, MR2, DC-SIGN, Syk, Card-9, Bcl-10, Malt-1, Src, DEC-205, Tim-3, Trem-1, and DAP-12 in patients with OME, COM, and Chole OM.MethodsCLR mRNA levels in patients with OME, COM, and Chole OM were assessed by real-time polymerase chain reaction. The level of expression of each mRNA was compared in patients with and without bacteria, and in patients with conductive hearing loss (CHL) and sensorineural hearing loss (SNHL).ResultsThe patterns of expression of CLRs differed in patients with OME, COM, and Chole OM. Galectin-1 mRNA level was significantly higher in the COM than in the Chole OM group (p < 0.05), and MR1 and Galectin-1 mRNA levels among patients with CHL were significantly higher in those with COM than with Chole OM (p < 0.05). Galectin-1 mRNA level among patients with SNHL was also significantly higher in the COM than in the Chole OM group (p < 0.05).ConclusionsThe levels of expression of mRNAs encoding the CLRs Dectin-1, MR1, MR2, DC-SIGN, Syk, Card-9, Bcl-10, Malt-1, Src, DEC-205, Tim-3, Trem-1 and DAP-12 differ among patients with OME, COM, and Chole OM.