胆脂瘤型中耳炎的病理行为及临床演变模式

胆脂瘤型中耳炎是慢性中耳炎的一种常见类型,它常破坏听骨链、面神经管及中耳腔周围颅骨,引起严重听力下降和颅内外并发症.虽经数代耳科学家努力,对其发病机理仍不清楚,对其病理行为和临床演变模式缺乏深入研究,因而对其临床认知水平低,特别是对其预防无从着手.为提高对胆脂瘤型中耳炎的临床认知能力、诊治和预防水平,本文着重对胆脂瘤型中耳炎的病理行为和临床演变模式进行探讨.     

中耳炎隐蔽性发病的病理因素探讨

为探讨中耳炎的隐蔽性发病的病理因素，用光镜对３０６耳各型中耳炎颞骨连续切片，进行病理学观察研究和临床资料复习。结果示，绝大多数中耳炎病变过程中缺少临床症状。     

中耳炎病理过程中肉芽组织的形成及病理影响和转归

肉芽组织是慢性中耳炎最常见的、具有代表性的标志性病变,它的不断形成、病理影响和转归贯穿在慢性中耳炎的整个病理全过程当中[1]。对这些问题的研究和认识将有助于对慢性中耳炎病理的透彻理解和临床上正确有效地诊治该病。     

中耳炎--一个古老而不衰的课题

耳炎是一个古老的课题，早在耳鼻咽喉科尚未分化为一个独立的学科之前，其治疗就开始了，然而迄今发病率依然很高。随着现代医学和科学技术的发展，对它的认识和治疗有了很大进展。中耳炎是一个常见病和多发病，严重影响着人类的健康和生活质量。因此我国耳鼻咽喉科学工作者迫切感到有必要坐到一起，对中耳炎的分类分型和手术治疗的分类进行讨论，以更好地指导临床实践。     

中耳炎临床分类和手术分型指南（2012）解读北大核心CSCD

中耳炎是耳科临床常见病与多发病,从病因、病程、病理等不同角度出发,可有多种分类方法;根据病变性质和范围,中耳炎手术也存在多种分型。为规范国内中耳炎临床分类及手术分型标准,中华医学会耳鼻咽喉科学分会和本刊编委会于2004年在西安组织讨论并制订了《中耳炎的分类和分型》（简称“西安指南”）。“西安指南”对规范我国中耳炎的临床诊断和治疗、手术疗效评价及学术交流等起到了积极的促进作用。随着中耳炎基础与临床研究的不断深入,“西安指南”已不能完全适应临床发展的需要。为此,编辑部2011年4月在昆明组织召开中耳炎分类和分型标准修订专家研讨会,遵循“简明、准确、规范、接轨”的原则,参考国际现有标准及最新主流观点,结合我国国情特点,对“西安指南”进行了修订,之后又几经讨论修改,最终推出2012版的中耳炎临床分类和手术分型指南。为了便于读者深入理解并应用于临床实践,本期同时刊出该指南的解读文章。     

肺炎链球在中耳炎的致病机理及其防治的研究近况

肺炎链球菌为中耳炎的常见致病菌之一，导致中耳炎的只是常见几种菌型。鼻咽部的肺炎链球菌与中耳炎有密切相关。该菌的致病性与其粘附力，抗原特性及降解成分等有关。可根据常见菌型制备疫苗进行预防。治疗以敏感的抗生素为主，抗体疗法及维持鼻咽部正常菌群还有待探索。     

中耳炎

中耳炎是儿童的高发病。中耳炎的病因病理是多因素的，包含免疫反应、咽鼓管功能障碍、细菌和病毒的感染、遗传以及环境因素等。早期的观察适用于大多数中耳炎儿童；对于被确诊为急性中耳炎的两岁以内的患儿，建议使用抗生素。手术方法的选择取决于合并症、儿童的生长发育状况以及对自发性渗出液的预期估计。推荐的手术方法有鼓室置管术、腺样体刮除术等。然而，到目前还没有理想的治疗方法，需要探索新的、基于现代中耳炎的病因病理理论的有创意性的治疗方法。     

影响中耳炎术后干耳的相关因素研究进展

中耳炎是耳科常见疾病,多由急性中耳炎未能及时治愈迁延而成。中耳炎的分类经历了时代的变迁,2012年中耳炎临床分类和手术分型指南将中耳炎分为分泌性中耳炎、化脓性中耳炎、中耳胆脂瘤和特殊类型中耳炎4大类,化脓性中耳炎又分为急性化脓性中耳炎及慢性化脓性中耳炎,对于慢性化脓性中耳炎及中耳胆脂瘤的患者,手术是主要的治疗方法。手术的目的是在清除病变组织、获得干耳、阻断疾病的进一步发展及其并发症形成的前提下,提高听力及患者的生活质量。但有部分患者术后仍会出现持续或间断流脓,甚至病变复发需要再次手术。因此,如何提高中耳炎术后干耳率,是所有耳科医师追求的目标。     

血管内皮生长因子在分泌性中耳炎发展中的调控作用

血管内皮生长因子是一种重要的血管通透性和血管生成的调节因子，在炎症反应中发挥着重要的作用。分泌性中耳炎是儿童听力下降的常见原因，其病理改变主要是炎症反应。已有多项研究在分泌性中耳炎动物模型及儿童患者中均检测到血管内皮生长因子mRNA的表达。本文综述血管内皮生长因子在分泌性中耳炎发生发展中的调控作用，为分泌性中耳炎病因的进一步研究及治疗方法提供参考。     

嗜酸性粒细胞性中耳炎研究进展

嗜酸性粒细胞性中耳炎是一种难治性中耳炎，其主要特点是中耳积液中富含有嗜酸性粒细胞，患者常伴有哮喘和/或鼻息肉。对中耳炎的常规治疗，如药物治疗、鼓膜穿刺、鼓膜切开、鼓室置管等治疗方式效果欠佳。最新的研究发现局部或全身使用类固醇激素及生物靶向治疗的效果好于传统治疗方式。嗜酸性中耳炎的临床诊断较复杂，容易因误诊、漏诊等原因错过最佳的治疗时机。本文就嗜酸性粒细胞性中耳炎的可能发病机制、临床诊断及治疗方法做一综述，提高临床对该疾病的认识，为诊疗提供理论依据。     

HPV and head and neck cancer

Head and neck cancer is frequent worldwide and oropharyngeal locations are presently sharply on the increase, in relation with an increasing incidence of oropharyngeal infection by oncogenic type-16 human papillomavirus (HPV). The clinical and biologic profile of these patients is distinct from that of other oropharyngeal carcinoma patients, with earlier onset, cystic cervical nodes and basaloid carcinoma histopathology. Detection of intratumoral viral DNA is essential to confirm the role of HPV, and E6/E7 mRNA expression is the most relevant indicator for stratification. Several methods can reveal intratumoral oncogenic HPV DNA, but PCR with hybridization is the most sensitive and most widely used. According to several reports, prognosis in terms of survival and locoregional control is better in HPV-positive oropharyngeal carcinoma than in oropharyngeal carcinoma associated with smoking and alcohol consumption. The future lies in vaccination, but further studies will determine whether the rate of oropharyngeal carcinoma falls in women vaccinated against cervical cancer.     

Papillomavirus and head and neck cancer

Tobacco and alcohol consumption are the main risk factors for head and neck cancers. Papillomavirus (HPV) infection was recently associated with the development of malignant tumors of the oropharynx, according to molecular and biological arguments. We describe the oncogenic mechanisms of HPV infections, the epidemiological and clinical aspects of associated head and neck cancers, their prognosis, and issues of specific therapeutic strategies.     

紫杉醇与头颈部肿瘤

为了解紫杉醇治疗鼻咽癌、喉癌及其他头颈部肿瘤的疗效及作用机理，本文分析了近年来的文献27篇。紫杉醇通过稳定微管、阻断细胞的有丝分裂和增殖，从而显著地抑制肿瘤细胞的生长并促进细胞调亡，在头颈部肿瘤同期放化疗中能起到放疗增敏作用，单独或联合其他抗癌药物治疗亦有较佳的疗效。紫杉酵是一种具有良好抗癌活性的药物，随着研究的深入，将会在头颈部肿瘤的治疗中发挥更大的作用。     

Aging and olfactory and taste function

This article focuses on the change in olfaction and taste with aging. It discusses histopathology with an emphasis on age-related changes, causes of chemosensory dysfunction in the elderly, how to evaluate a patient with dysfunction, useful tests and imaging, clinical consequences of chemosensory impairments, and available treatment options.     

Nutrition and taste and smell dysfunction

Food selection plays a pivotal role in maintaining adequate nutrient intake, thus elucidating drivers of food choice is a meaningful strategy to maintain health and manage disease. Taste and smell are key determinants of food choice and warrant careful consideration. In this review, we first discuss how sensory stimulation influences food selection and metabolism. We then review the evidence regarding the relationship between taste and smell dysfunction and food preferences and selection, with attention given to contexts of certain chronic diseases. We conclude with brief recommendations for the management of chemosensory disorders. While sensory abilities influence food selection, the effect of taste and smell dysfunction on long-term consumption patterns and health status must be considered in light of environment, exposure, and culture.     

Pepsin and Laryngeal and Hypopharyngeal Carcinomas

Laryngeal and hypopharyngeal carcinomas are common malignant tumors of the head and neck, and the incidence of both is increasing. Laryngopharyngeal reflux refers to the retrograde flow of gastric contents into the larynx, oropharynx, and/or nasopharynx. It remains controversial whether laryngopharyngeal reflux is a risk factor for laryngeal and hypopharyngeal cancers. The refluxing substances mainly include hydrochloric acid, pepsin, and occasionally bile acids and bile salts, as well as bacteria that colonize the gastrointestinal tract. Loss of epithelium in the mucous membrane of the larynx and hypopharynx is thought to be caused by pepsin. Here, we review the relationships between laryngopharyngeal reflux and both laryngeal and hypopharyngeal carcinomas, as well as the significance of pepsin, methods of clinical detection, and the mechanism of carcinogenesis.