丹参酮滴耳液对豚鼠耳部形态学影响的研究

目的探讨丹参酮滴耳液在中耳局部应用时是否对豚鼠耳部结构形态存在不良影响。方法选取耳廓反应良好的豚鼠20只作为试验动物,采用自身对照,右耳作为实验组,左耳作为对照组,分别鼓膜穿刺注入丹参酮滴耳液、生理盐水,持续7d及14d,试验结束后,剥离颞骨取出听泡观察中耳腔黏膜情况,全耳蜗铺片、显微镜下病理学检查、扫描电镜进行形态学观察。结果形态学研究表明,丹参酮滴耳液组和生理盐水组比较,中耳腔黏膜未见异常改变,耳蜗铺片结构清楚,未见内外毛细胞缺失,显微镜观察中耳黏膜无异常发现,扫描电镜观察见内外毛细胞形态正常,未见有明显的缺失。结论豚鼠动物试验证明,丹参酮滴耳液对耳部形态无不良影响。     

普米克令舒在慢性化脓性中耳炎活动期治疗中的应用

目的观察使用普米克令舒（吸入用布地奈德混悬液）和氧氟沙星滴耳液联合局部用药对慢性化脓性中耳炎活动期的治疗效果。方法将40例慢性化脓性中耳炎活动期患者随机分为治疗组与对照组,治疗组使用普米克令舒与氧氟沙星滴耳液的混合液点耳,对照组单纯使用氧氟沙星滴耳液点耳,7 d为一个疗程,记录干耳时间。两组间采用t检验比较干耳时间的差异。结果治疗组干耳时间平均为（5.05±1.40）d,对照组干耳时间平均为（10.45±3.54）d,经比较治疗组干耳时间明显比对照组干耳时间缩短,差异具有统计学意义（t=6.18,P〈0.01）。患者干耳后,随访1个月,均无复发。结论慢性化脓性中耳炎常合并中耳黏膜过敏,与长期不干耳密切相关。将普米克令舒与氧氟沙星滴耳液混合应用于治疗慢性化脓性中耳炎的局部治疗,有利于炎症消退和干耳,具有一定的临床应用价值。     

大鼠急性中耳炎动物模型的建立

目的 建立大鼠急性中耳炎模型并探讨其应用价值.方法 36只健康雄性SD大鼠,麻醉后将50μl肺炎链球菌悬液(1×108CFU/ml)经听泡穿刺注入到大鼠左侧中耳腔(实验耳),右侧注入等量生理盐水(对照耳),分别于注入后1、3、5、7、10、14天各取6只大鼠,行鼓室声导抗测试,手术显微镜下观察鼓膜及中耳腔,中耳腔分泌物或灌洗液细菌培养鉴定,中耳黏膜骨壁HE染色切片检查,动态观察大鼠中耳炎的病理变化及病程转归.结果实验耳注入肺炎链球菌后,感染早期(1天、3天)为急性化脓期,见鼓膜充血,中耳黏膜部分坏死脱落,中耳腔蓄积以中性粒细胞浸润为主的大量炎性渗出物;感染中期(5天、7天)急性化脓性炎症减退,以淋巴细胞、浆细胞浸润为主,黏膜肉芽及纤维增生,中耳积液细菌培养阳性率100%;感染后期(10天、14天)部分实验耳鼓膜色泽恢复正常,听泡内脓液消失,但各有部分耳(2/6耳)转归成分泌性中耳炎表现.结论 本研究建立了急性中耳炎的大鼠模型,成功率100%,是研究人类中耳炎较为理想的动物模型,不仅可用于急性化脓性中耳炎的研究,也可用于急性分泌性中耳炎的研究.     

水杨酸钠中耳灌注对庆大霉素耳毒性的防护作用

目的 观察水杨酸钠经中耳局部灌注给药对庆大霉素耳毒性的防护作用。方法 24只健康杂色豚鼠均接受圆窗置管术，然后随机分成3组：Ⅰ组为生理盐水对照组；Ⅱ组为庆大霉素组，腹腔注射庆大霉素，经听泡灌注生理盐水；Ⅲ组为庆大霉素加水杨酸钠组，腹腔注射庆大霉素，经听泡灌注水杨酸钠。观察各组给药前后听性脑干反应阈的变化和给药后4周毛细胞损失情况。结果 听泡置管术后ABR反应阈无明显改变；给药后2周和4周，庆大霉素组ABR反应阈较庆大霉素加水杨酸组显著增高（P〈0．01），对照组ABR反应阈无显著变化。耳蜗铺片、毛细胞计数显示庆大霉素组外毛细胞严重缺失，以底回最明显，庆大霉素加水杨酸钠组外毛细胞损失较庆大霉素组轻（P〈0．05）。对照组无明显外毛细胞缺失。结论 水杨酸钠经中耳局部给药途径可减轻庆大霉素所致听功能损害和毛细胞缺失，可在一定程度上有效预防庆大霉素的耳毒性。     

中耳急性炎症对内耳微血管渗透性的影响

目的　探讨中耳急性炎症对豚鼠内耳微血管渗透性及听阈的影响。方法　将 16只纯白红目豚鼠麻醉后 ,在无菌条件下于右耳经鼓膜注射 1× 10 8 L的金葡菌液 10 0 μL ,左耳作正常对照 ,制成急性化脓性中耳炎模型。三天后利用胶体镧示踪及透射电镜技术观察豚鼠耳蜗胶体镧渗入情况及形态学改变。造模前及造模后 3天 ,分别测对照耳和实验耳ABR阈值。结果　急性炎症作用后三天 ,豚鼠实验耳听阈明显升高 ,透射电镜下可见Cortis器毛细胞与支持细胞之间有高密度镧离子 ,组织间隙内也可见镧离子渗透 ,并可见渗出镧离子沿神经纤维走行。血管纹血管内皮细胞连接及细胞质内可见高密度镧颗粒。结论　中耳急性炎症早期内耳微血管渗透性即发生改变并可能与听阈升高有一定关系     

巴曲酶在实验性分泌性中耳炎中的防治作用

目的 验证巴曲酶（Batroxobin,DF-521）对实验性分泌性中耳炎的防治作用。方法 选用豚鼠,先测声导抗、听性脑干反应（ABR）阈值。麻醉状态下做实验性分泌性中耳炎动物模型,当动物鼓室导抗由A型变为B或C型,动物造模成功。此时,用微量注射器将5μl巴曲酶（1BU DF－521)用0.3ml生理盐水稀释的巴曲酶注射入双侧中耳腔内（DF－521组,8只）;同样将等量地米松（激素组,8只）和生理盐水（生理盐水组,6只）分别注入双侧中耳腔做为对照,一周后,再测动物 导抗,ABR瓶值。取中耳标本进行形态学和中耳粘膜纤维连接蛋白免疫组织化学检查。结果 DF－521组动物鼓室导抗图由B型变为A或C型比例高于激素组和生理盐水组,形态学检查,三组中耳标本比较,DF－521组中耳粘膜炎性反应最轻,免疫组化示中耳粘膜纤维连接蛋白在DF－521组表达最低。结论 DF－521可治疗分泌性中耳炎,且能有效地预防其发展为粘连性中耳炎,是一种较激素为好的临床用药。     

浅论健脾疏肝通窍法治疗儿童慢性分泌性中耳炎

分泌性中耳炎是以中耳积液及听力减退为主要特征的中耳非化脓性炎症。由于咽鼓管粘膜肿胀,管腔阻塞,致中耳的通气引流不畅,造成中耳腔出现非化脓性的液体潴留,即所谓“中耳积液”而致鼓膜活动度降低、听力减退。本病可分为急性和慢性两种,急性分泌性中耳炎病程延续68周,中耳炎症未愈者可称为慢性分泌性中耳炎。分泌性中耳炎在中医属“耳胀”、“耳闻”范畴。耳胀为病之初起,以耳内闷胀为主,或兼有疼痛,类似急性分泌性中耳炎;耳闻为病之久者,耳内如物阻隔,听力明显下降,迁延难愈,类似慢性分泌性中耳炎。古代医家对本病的病因病机有着较深入的…     

急性化脓性中耳炎豚鼠耳蜗形态和功能改变

对3只因听泡置管导致急性化脓性中耳炎发作的豚鼠进行了脑干诱发电位（ABR）测试和耳蜗Corti氏器扫描电镜观察。发现3只豚鼠患耳Corti氏器均有程度不等损害，ABR阈分别提高45、60和30dB。提承急性中耳炎可引起内耳形态和功能变化。文中对引起损害的机制进行了讨论。     

中耳炎颞骨咽鼓管峡部粘-软骨膜的组织病理学观察

目的：了解中耳炎性病咽鼓管峡部粘－软骨膜的影响。方法：用光镜对３２耳各型中耳炎颞骨（中耳炎组）与５０耳正常颞骨（正常组）标本连续切片的咽这峡部粘－软骨膜，中耳腔鼓岬粘骨组织病理学比较观察。结果：中耳炎组和正常组颞骨标本咽鼓管峡部均无病理性阻塞；中耳炎组峡部粘－软骨膜厚度测量和病理观察，未见有明显炎症改变，与正常组比较无明显差异；而其中耳腔粘骨膜均明显炎症病变。这种炎症截然不同反应的界限恰好在咽这的     

耳部疾病中西医结合临床治疗及研究概况

5.慢性非化脓性中耳炎 慢性非化脓性中耳炎,亦称慢性卡他性中耳炎,简称胶耳,为中耳腔粘膜的非化脓性迁延性炎症。多由急性中耳炎治疗不彻底或误诊造成,不少病者有自身免疫功能低下,该病为耳科常见病。儿童较多见,常为致聋原因之一,预后之好坏与病程长短、鼓室病变轻重呈正比,目前西医对此尚缺乏较好的治疗方法,而中西医结合治疗具有一定优势。     

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。     

听性脑干反应（ABR）测试在儿童分泌性中耳炎诊治中的作用

目的探讨听性脑干反应（auditory brainstem response,ABR）测试在1岁6个月～6岁的儿童分泌性中耳炎诊治中的应用价值。方法①在首诊时采用ABR测试97例179耳1岁6个月～6岁的分泌性中耳炎患儿,根据反应阈提高的程度分为3组：轻度组为20～30dB nHL,中度组为40～60dB nHL;重度组为70～90dB nHL。以同一年龄段的正常小儿为对照组,分析4组ABR波潜伏期和波间期的特点。②选择轻,中度组病例各10例（20耳）、重度组5例（10耳）,行鼓膜穿刺或鼓膜切开术,分析中耳积液量和性状与ABR波潜伏期的关系。③随诊治疗中,每周检测ABR一次,以监测疗效,并以对照组ABR潜伏期和反应阈为指标判断预后。结果①轻、中、重度3组随着ABR反应阈的提高,Ⅰ、Ⅲ、Ⅴ波潜伏期延长增多,而波间期无明显变化。②轻、中度组随着中耳积液的增多变稠,ABR的Ⅰ、Ⅲ、Ⅴ波潜伏期延长增多。重度组中耳积液与中度组无明显差异,而Ⅰ、Ⅲ、Ⅴ波潜伏期延长却明显增加。③轻、中、重度3组预后不同。结论在分泌性中耳炎的诊治中,声导抗测试虽能为中耳病变提供重要依据,但辅以ABR测试,不仅能提供更多的中耳信息,还能反映内耳功能和高频听觉状态,作为该病诊断以及判断疗效和预后的依据。     

Experimental otitis media induced by nonviable Moraxella catarrhalis in the guinea pig model

Moraxella catarrhalis is a normal resident of the human nasopharyngeal flora, but it is also isolated from middle ear fluid of acute otitis media and otitis media with effusion patients. To determine whether M. catarrhalis has direct pathogenicity in the middle ear, heat-killed M. catarrhalis was inoculated into the middle ear bullae of guinea pigs, and the inflammatory response was investigated. Middle ear mucosal histopathology observed in M. catarrhalis-inoculated ears included subepithelial edema, capillary dilatation, thickening of lamina propria mucosa, inflammatory cell and erythrocyte infiltration into the lamina propria mucosa. Inflammatory cell numbers, lysozyme and myeloperoxidase concentrations in the middle ear washing suspensions of M. catarrhalis-inoculated ears were significantly higher than control ears throughout the experiment. Therefore, nonviable M. catarrhalis induced middle ear inflammation and mucoperiosteal histopathology, which might be caused by direct injury of the nonviable bacteria (e.g. lipooligosaccharide or outer membrane proteins) and metabolic products of inflammatory cells.     

Tos改良联合进路鼓室成形术短期疗效观察

目的：观察Tos改良联合进路鼓室成形术治疗慢性化脓性中耳炎的短期疗效。方法：回顾性分析26例（28耳）施行改良联合进路鼓室成形术病例,总结技术特点,观察手术并发症及术后听力。结果：26耳（92.86%）干耳;3耳术后鼓膜再穿孔（10.71%）,其中2耳微小穿孔经处理后愈合。24耳术后3-6个月鼓膜恢复光锥,其中22耳保持鼓膜前倾角,1耳鼓膜-外耳道前壁夹角变钝,1耳鼓膜外移愈合。1耳再发性上鼓室内陷囊袋形成,1耳胆脂瘤复发。无听力下降、面瘫病例。手术前后纯音测听结果比较示：术后听阈[（42.80±17.97）dB]优于术前[（47.49±18.01）dB],差异有统计学意义（P〈0.05）,术后气骨导差[（19.76±7.49）dB]较术前[（30.65±10.02）dB]显著缩小（P〈0.01）。结论：改良联合进路鼓室成形术能有效清除鼓室及乳突病灶,并形成稳定的中耳含气腔和传声结构,适用于慢性化脓性中耳炎,尤其是气化不良乳突的完壁式乳突切除鼓室成形术。     

Ototoxic effect of Burow solution applied to the guinea pig middle ear.

OBJECTIVE: To analyze the ototoxicity of Burow solution as an otologic preparation. BACKGROUND: Burow solution has been used for years in the treatment of acute or chronic otitis externa and chronic suppurative otitis media. This acidic solution has antibacterial and antiedematous properties. Ototoxic effect of Burow solution has not been known, so the current study was designed to observe the ototoxic effect of Burow solution experimentally. MATERIALS AND METHODS: Experiments were performed in 32 young, male albino guinea pigs (weight, 450-550 g). Twenty animals in the experimental group were divided into 2 groups of 10 animals each. The first group received 13% Burow solution (13% aluminum subacetate), and the second received 4% Burow solution (4% aluminum subacetate). Twelve animals in the control group were divided into 2 groups of 6 animals each. The first group received gentamicin (40 mg/mL; ototoxic control), and the second received saline solution (negative control). Under general anesthesia, pretreatment auditory brainstem responses (ABRs) from the right ear were obtained from the animals in all groups. The right tympanic membranes were widely perforated, and a small piece of Gelfoam was applied to the middle ear. Ear solutions at concentrations of 0.1 mL were applied through transcanal approach to the middle ear twice a day in 10 days. Under general anesthesia, the Gelfoam was removed from the right middle ear, and posttreatment ABRs were obtained 14 days later after the initial time in all groups. RESULTS: Baseline ABR results were normal in right ears of all animals tested. Animals undergoing placement of Gelfoam with either 13% Burow solution, 4% Burow solution, or saline in the middle ear showed no changes in ABR threshold. The gentamicin group showed significant change in the ABR threshold. CONCLUSION: Burow solution was considered to be an effective and safe otologic preparation.     

Middle ear fluid lysozyme source in experimental pneumococcal otitis media

Middle ear infection with Streptococcus pneumoniae is important in the pathogenesis of acute and chronic otitis media, and lysozyme in middle ear fluid (MEF) is an important inflammatory mediator in this disease. To determine the source of lysozyme during the early period of acute pneumococcal otitis media, chinchillas were irradiated to induce neutropenia, and their middle ears were inoculated with heat-killed, encapsulated pneumococci. The number of inflammatory cells and concentration of lysozyme were measured in MEF between 6 and 72 hours after inoculation. In pneumococcus-inoculated ears, the mean number of inflammatory cells but not lysozyme was significantly lower in MEF from irradiated animals than that from nonirradiated animals at 6 hours. Since lysozyme accumulated in MEF before the influx of inflammatory cells in irradiated animals, the initial release of this inflammatory mediator is most likely not from inflammatory cells; and mucosal epithelial cells, the only other known source of lysozyme in the middle ear environment, were the probable source induced by the direct stimulation of pneumococci. Inflammatory cells may contribute lysozyme later in the inflammatory response, since cellular and lysozyme concentrations in irradiated and nonirradiated animals were similar between 24 and 72 hours. These results suggest that future therapeutic interventions to limit middle ear inflammation in acute otitis media may need to recognize the direct action of pneumococcal cells or their envelope components on middle ear epithelium.     

Labeling of the glucocorticoid receptor and Na,K-ATPase in a rat otitis media model

HYPOTHESIS: Glucocorticoid hormones exert an influence on the inflammatory response of the middle ear during acute otitis media. Rats with experimentally induced purulent otitis media were given either glucocorticoid hormones in excess or a glucocorticoid hormone blocker that deprived the animals of the hormone. BACKGROUND: Acute otitis media is a common inflammatory disease among children. Streptococcus pneumoniae is the most usual causative agent. The standard treatment today is phenoxymethylpenicillin. The role of glucocorticoid hormones in inflammatory reactions in the middle ear has been widely debated. METHODS: In an otitis media model, a suspension of pneumococci was inoculated into the bulla of the rat, after the animals were pretreated with either a dose of corticosteroid hormones or the glucocorticoid receptor blocking agent RU 486. Rats with induction of otitis media only, but no pretreatment, were used as control subjects, as were the left control-operated ears of all rats. The inflammatory response in the inner ear and in the middle ear was evaluated. The presence of glucocorticoid receptors and the enzyme Na,K-ATPase was investigated with immunohistochemistry. RESULTS: The inflammatory response in the animals with untreated otitis media and in the group with otitis media in rats pretreated with the receptor blocker was much more extensive than in the group of animals pretreated with corticosteroids. In the corticosteroid-treated group, the tympanic membrane and the mucous membrane of the middle ear were less edematous, but the middle ear cavity contained more pus. Only a few lymphocytes were found in the inner ears of these rats. When the inner ear was labeled with antibodies against glucocorticoid receptors, there seemed to be no difference between the labeling patterns in the three groups. This was also the case for antibody labeling against Na,K-ATPase. CONCLUSION: The present results indicate that the reaction in the middle ear mucous membrane is more pronounced in rats that had been pretreated with the hormone receptor blocking drug. An increase of corticosteroid hormone levels during the inflammatory process seem to diminish the reaction in the tympanic membrane and the middle ear mucosa. Neither the hormone receptor blocking drug nor the steroid hormones change the content of glucocorticoid receptors and Na,K-ATPase in the inner ear in the otitis media rat model.     

Course of IL-1beta, IL-6, IL-8, and TNF-alpha in the middle ear fluid of the guinea pig otitis media model induced by nonviable Haemophilus influenzae.

To characterize the local response in acute otitis media, courses of interleukin (IL)-1beta, IL-6, IL-8, and tumor necrosis factor (TNF)alpha in middle ear fluid (MEF) of the guinea pig otitis media model induced by nonviable Haemophilus influenzae were investigated with enzyme-linked immunosorbent assay (ELISA) kits. The IL-1beta concentration in H. influenzae-inoculated ears peaked 24 hours after inoculation. The IL-8 concentration was significantly higher in H. influenzae-inoculated ears than in controls 48 and 96 hours after inoculation. The TNF-alpha concentration in H. influenzae-inoculated ears had an initial peak 6 hours after inoculation and had significant late increases 48 and 96 hours after inoculation. The results suggest that IL-1beta and TNF-alpha were produced by middle ear mucosa in the early stage of the experiment by stimulation of bacterial inoculation, which caused subsequent inflammatory cell accumulation, and that IL-8 and TNF-alpha were produced in the late stage by accumulating inflammatory cells.     

Effects of Burow's solution as an ear drop on Intractable chronic suppurative diseases of the external ear canal and middle ear

OBJECTIVE: Burow's solution was developed by Karl August von Burow in the 19th century as an ear drop. Thorp et al. reported its excellent effect on chronic suppurative otitis media in 1998. We applied Burow's solution to intractable chronic purulent diseases of the external and middle ear in the 12 months from February 2001. SUBJECTS: Subjects were 25 ears of 21 patients--35-79 years old, 10 men's ears and 15 women's ears--whose disease has continued for an average of 3.78 years. Diseases and patients are as follows: 1) 11 ears with postoperative mastoid cavity problems, 2) 7 ears with chronic external otitis and chronic eczema of the external ear canal, 3) 7 ears with fungal otitis externa, 4) 6 ears with chronic otitis media with perforation, and 5) 2 ears of chronic granulated myringitis. METHOD: The solution was dropped into the ear canal once a day for 10 min or cotton balls soaked with the solution were applied to the canal wall. Criteria of efficacy were divided into cured, effective and unchanged. RESULTS: 8/11 ears with a cavity problem were cured (72.7%) and 3 ears showed treatment to be effective. All 7 ears with chronic external otitis and chronic eczema were cured. All 7 ears with fungal otitis externa were cured. 4/6 ears (66.6%) with chronic perforated otitis media were cured and 1 ear each showed treatment to be effective and 1 unchanged. Two chronic granurated myringitis were cured. Twenty of 25 ears (80%) were cured. Pre- and posttreatment audiometries showed almost the same. The cure appeared within 3 days to 3 weeks. The solution was not effective against mucoid secretion, cholesteatoma, or residual mastoid cells. The day after treatment, serous secretion appears temporarily. CONCLUSION: Burows's solution is seemed to be very effective and nonototoxic as an otic drop for treating suppurative ear diseases.