分泌性中耳炎中耳积液中肿瘤坏死因子—α的检测

目的：为探讨分泌性中耳炎（ＯＭＥ）患者中耳积液（ＭＥＥ）中肿瘤坏死因子－α（ＴＮＦα）的存在及其在ＯＭＥ发生中的作用。方法：运用酶联免疫吸附法（ＥＬＩＳＡ）检测３３例ＯＭＥ患者ＭＥＥ及血清中ＴＮＦα的浓度。结果：ＭＥＥ中ＴＮＦα的含量明显高于对应血清中含量（Ｐ＜０００１）；粘液组ＭＥＥ中ＴＮＦα的含量明显高于浆液组ＭＥＥ中的含量（Ｐ＜０００１）；儿童组中耳积液ＴＮＦα水平明显高于成人组（Ｐ＜０００１）。结论：中耳局部可产生ＴＮＦα，ＴＮＦα可能与ＭＥＥ的形成有关；粘液性中耳炎ＴＮＦα明显增高，反映其局部炎症程度较浆液性中耳炎重；儿童、成人ＭＥＥ中ＴＮＦα的水平差异表明发病机理可能有所差别。     

Prognostic factors for otitis media with effusion in infants

To determine the prognostic factors for otitis media with effusion (OME) in 1-year-old infants, we studied 240 patients and 366 controls in a case-cohort study. On univariate analysis factors which were associated with OME were family history, older siblings, upper respiratory infections and acute otitis media (AOM). After multivariate analysis, however, only the occurrence of more than four upper respiratory infections and children with older siblings were associated with OME. Thus, upper respiratory infections and older siblings appear to be related to the development of OME.     

Genetic background and the risk of otitis media

Objective

Otitis media is a multifactorial disease where genetic background may have an important role. For genome-wide association studies, it is important to understand the degree of heritability. The objective of this study was to estimate the heritability of recurrent acute otitis media and chronic otitis media with effusion.

Methods

Children operated because of recurrent or chronic otitis media at the Helsinki University Central Hospital, Finland, as well as their families were recruited during 2008-2009. A cohort of 2436 subjects was enrolled consisting of 1279 children and their parents. The study subjects answered a questionnaire concerning their otitis media history and treatment, as well as tobacco exposure, allergy and asthma history. Heritability estimates were calculated for recurrent acute, chronic and any episodes of otitis media using software especially designed for estimating heritability in family cohorts.

Results

Altogether 901 subjects suffered from recurrent otitis media and 559 from chronic otitis media with effusion. The heritability estimates in our cohort were 38.5% for recurrent (P = 7.3 × 10⁻⁹), 22.1% for chronic (P = 4.6 × 10⁻³) and 47.8% for any otitis media (P = 1.5 × 10⁻¹¹).

Conclusions

Our results demonstrate a moderately strong and statistically significant genetic component for both recurrent acute otitis media and chronic otitis media with effusion. These results highlight the importance of unraveling the genetic factors for otitis media that are still poorly known.     

Factors associated with positive bacteriological cultures of chronic middle ear effusions

Pathogenic bacteria have been isolated from middle ear effusions in a number of studies. Our aim was to identify factors which predispose to patients having positive cultures. Over a 1-year period, prospective data were collected on patients admitted for myringotomy. Middle ear effusions were collected at the time of surgery using specially designed traps, and underwent microscopy and culture. Data on local weather parameters were obtained from the Meteorological Office in Edinburgh, UK and compared with the patterns of positive cultures. A higher proportion of cultures were positive in October, November and December and in February and May than in the other months of the year. We were not able to relate these variations to any of the meteorological data, with the possible exception of relative humidity, or to any other variable.     

Risk factors for chronicity in childhood otitis media with effusion

One hundred and ninety-one children who presented to the author’s clinic with otitis media with effusion (OME) over a 2-year period (1986–1988) have been studied prospectively. Resolution of their OME was considered to have occurred when they had normal findings on pneumatic otoscopy, tympanometry and audiometry on at least two occasions 6 months apart and had subjectively normal hearing in between. The number of operations performed during the course of the disease was used as a surrogate for chronicity. Children with a history of previous aural discharge at presentation were significantly more likely to have chronic OME (P = < 0.02).     

Quality of questionnaires for the assessment of otitis media with effusion in children

Objectives

Audiometric tests provide information about hearing in otitis media with effusion (OME). Questionnaires can supplement this information by supporting clinical history‐taking as well as potentially providing a standardized and comprehensive assessment of the impact of the disease on a child. There are many possible candidate questionnaires. This study aimed to assess the quality and usability of parent / child questionnaires in OME assessment.

Design and main outcome measures

Fifteen, published questionnaires, commonly used in audiological departments (Auditory Behaviour in Everyday Life (ABEL), Children's Auditory Performance Scale (CHAPS), Children's Home Inventory for Listening Difficulties (CHILD), Children's Outcome Worksheets (COW), Evaluation of Children's Listening and Processing Skills (ECLiPS), Early Listening Function (ELF), Fisher's Auditory Problem Checklist (FAPC), Hearing Loss 7 (HL‐7), Listening Inventory for Education‐ Revised (LIFE‐R Student), Listening Inventory for Education UK Individual Hearing Profile (LIFE‐UK IHP), LittlEARS Auditory Questionnaire (LittlEARS), Listening Situations Questionnaire (LSQ), Otitis Media 6 (OM‐6), Quality of Life in Children's Ear Problems (OMQ‐14), Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) were assessed according to the following 8 criteria: conceptual clarity, respondent burden, reliability, validity, normative data, item bias, ceiling/ floor effects, and administrative burden.

Results

ECLiPS, LittlEARS and PEACH scored highest overall based on the assessment criteria established for this study. None of the questionnaires fully satisfied all 8 criteria. Although all questionnaires assessed issues considered to be of at least adequate relevance to OME, the majority had weaknesses with respect to the assessment of psychometric properties, such as item bias, floor/ceiling effects or measurement reliability and validity. Publications reporting on the evaluation of reliability, validity, normative data, item bias and ceiling/floor effects were not available for most of the questionnaires.

Conclusions

This formal evaluation of questionnaires, currently available to clinicians, highlights three questionnaires as potentially offering a useful adjunct in the assessment of OME in clinical or research settings. These were the ECLiPS, which is suitable for children aged 6 years and older, and either the LittlEARS or the PEACH for younger children. The latter two are narrowly focused on hearing, whereas ECLiPS has a broader focus on listening, language and social difficulties.     

The Role of Fibrinolysis in Adhesive Otitis Media(AOM)

Objective To study the effects of Batroxobin on otitis media with effusion(OME), an early stage of Ad-hesive Otitis Media(AOM), for the purpose of expanding our understanding of the role of fibrinolysis in the patho-genesis of AOM. Method Forty cases of OME(45 ears) were randomly selected to receive intratympanic adminis-tration of Dexamethasone at 5 mg/ml(Group 1 or G1), Batroxobin at 1 BU/ml(Group 2 or G2) or Batroxobin at 2 BU/ml (Group 3 or G3). Pre- and post-treatment changes in clinical symptoms, the Air conduction Hearing Threshold (AHT) in pure tone audiometry and average AHT over 0.25 to 2 kHz were compared. Results Data from 31 eases(33 ears) were available for analysis. AHTs among three groups were similar prior to treatment(P> 0.05). The rate of normal hearing following treatment in G3 was 70% or 7/10, higher than in G1 (41.7% or 5/12) and G2 (54.5% or 6/11)(P < 0.05). The rate of improvement following treatment was 81.8% or 9/11 and 80.0% or 8/10 in G2 and G3, respectively, higher than that in G1 (50.0% or 6/12)(P< 0.05). Conclusions Therapeu-tic effects of intratympanic injection of Batroxobin on OME is superior to traditionally used Dexamethasone. In ad-dition, higher concentration of Batroxobin appears to be superior to lower concentrations. These findings confirm that fibrinolysis plays a pivotal role in the pathogenesis of middle ear adhesion and that fibrinolytic medicine can prevent or reduce adhesion development in the middle ear.     

乳突切除术治疗分泌性中耳炎

目的：探讨乳突切除术治疗分泌性中耳炎的疗效。方法：回顾性分析22例（24耳）行乳突切除手术的分泌性中耳炎患者,其中行完壁式并面隐窝开放手术20耳,开放式手术4耳,同期行鼓膜切开置管术3耳。术后6个月拔管,测试术前、术后的听力。结果：所有患者术后均未出现听力下降,19耳有不同程度的听力提高,鼓室导抗图为A型曲线者17耳,C型曲线者7耳。术后随访6-36个月,未见中耳炎复发。结论：对反复发作、长期迁延经治疗无效的分泌性中耳炎,乳突切除术可改善乳突、鼓窦、鼓室和咽鼓管的通气引流,减少分泌性中耳炎的复发。     

武汉市部分幼儿园儿童分泌性中耳炎患病率调查

目的：调查武汉市部分幼儿园儿童分泌性中耳炎患病率情况。方法：研究对象为武汉市部分幼儿园3岁～6岁的儿童,持续时间3年,常规耳鼻咽喉科体检,耳镜检查结合声导抗测试。患病率病率以百分比表示,统计学差异分析采用卡方检验。结果：武汉市部分幼儿园儿童分泌性中耳炎患病率为6．67％,男女之间患病率无统计学差异,3岁患病率明显高于4～6岁。结论：幼儿园儿童中耳炎患病率较高,有急性中耳炎病史且经常鼻塞的小孩要定期进行耳鼻咽喉科体检,有必要对幼儿园儿童进行常规耳镜和声导抗检查。     

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.     

A pilot study to investigate the therapeutic effect of Valsalva maneuver on otitis media with effusion in adults

Objective

This pilot study was performed to investigate the therapeutic effect of Valsalva maneuver on otitis media in adults and to evaluate the prognostic factors for the good response.

Predictors of outcome in children with otitis media with effusion

Otitis media with effusion (OME) is the commonest cause of hearing impairment in young children. The fluctuating nature of the condition makes identification of those with persistent disease difficult without subjecting each child to a period of ‘watchful waiting’. The aim of this study was to determine if the outcome of this observation period could in any way be predicted. The study involved the retrospective analysis of 517 children, aged 3–15 years (mean 5 years and 4 months) in whom the diagnosis of OME had been established. All children had been subjected to an observation period before a decision on surgery was taken. There was a significant correlation between the degree of hearing loss at presentation and after the period of observation. Sex was not a reliable predictor of outcome, but age less than 4 years and presentation in autumn or winter were associated with a poor audiometric outcome. This study identifies a predictive influence on the resolution of OME for these three factors and points the way for future research aimed at identifying the subgroup of children with OME who would benefit from early surgical intervention.     

Otitis media with effusion: a disability or not?

Otitis media with effusion (OME) is a disease most commonly affecting the paediatric population. However, it is a condition that is also seen in adults and does lead to significant morbidity. We studied the effect of surgical treatment of OME in an adult population and found that the subjective relief of symptoms exceeded the objective audiometric gain. In children where subjective symptoms are perhaps more difficult to assess the clinician needs to beware of underestimating the effect of a hearing loss.     

External ear resonance in children with otitis media with effusion

A middle ear effusion has been shown, in KEMAR, to increase the height of the resonant peak of the external auditory canal by 6 dB SPL. It has also been shown that the hearing impairment due to otitis media with effusion is related to the volume of middle ear fluid. Therefore, it was hypothesized that measurement of the height of the resonant peak of the external auditory canal could be used as a method of assessing the magnitude of any hearing impairment due to otitis media with effusion. 182 ears from 182 children aged 3–12 (mean 6.3) years were studied. Pure-tone audiometry and impedance tympanometry were performed, and the acoustics of the external auditory canal were measured using the Rastronics CCI-10 frequency response analyser. The mean height of the resonant peak (17.9 dB SPL) of children with a type A tympanogram was significantly different from the mean value (23.6 dB SPL) of those with a type B tympanogram. There was a significant correlation between the height of the resonant peak and the speech frequency average of the pure-tone thresholds. The sensitivity and specificity of using the height of the resonant peak to detect hearing impairments in different age groups were calculated and compared with the sensitivity and specificity of tympanometry. The test did not provide the same degree of sensitivity as tympanometry but was more specific. The additional advantages of the test are that it is quick, taking less than 1 min per ear, and is well tolerated by children in whom there was a 99% compliance. It is suggested that measurement of the height of the resonant peak of the external auditory canal holds potential as a quick and objective method of screening and monitoring the hearing impairment of children with otitis media with effusion.     

Influence of prednisolone on the secretion of mucin from the HT29‐MTX cell line

Influence of prednisolone on the secretion of mucin from the HT29‐MTX cell line Glucocorticoids have been used in the treatment of otitis media with effusion with promising but inconsistent results. The HT29‐MTX cell line is a completely differentiated and almost exclusively mucus‐secreting goblet cell line. To assess the potential of steroids in suppressing mucin secretion, we have studied the response of this cell culture to prednisolone. Confluent cell cultures were trypsinized, subcultured in six‐well plates and incubated with five doses of prednisolone from 10^?3 M to 10^?11 M and over a varying time course from 6 to 36 h. Analysis was performed using a monoclonal mouse antibody to human gastric mucin by dot‐blot ELISA. Prednisolone caused a consistent reduction in mucin production from this cell line. Increasing concentrations of prednisolone resulted in increasing suppression of MUC5AC secretion. There is a dose‐dependent suppression of mucin secretion by prednisolone, with a maximum effect of 21% over control seen at the highest steroid concentration used.     

Distortion product otoacoustic emission together with tympanometry for assessing otitis media with effusion in children

Objective: To investigate the diagnostic value of distortion product otoacoustic emission (DPOAE) together with tympanometry in assessing otitis media with effusion in children.

Methods: Three hundred and thirty-nine patients, who were diagnosed with obstructive sleep apnea–hypopnea syndrome (OSAHS) and prepared to undergo adenotonsillectomy and had a unilateral or bilateral type ‘B’ or ‘C’ tympanogram were enrolled in this study. Patients were divided into the following four groups: Group 1, type ‘B’ tympanogram with positive DPOAE; Group 2, type ‘B’ tympanogram with negative DPOAE; Group 3, type ‘C’ tympanogram with positive DPOAE and Group 4, type ‘C’ tympanogram with negative DPOAE.

Results: Tympanometry showed a type ‘B’ pattern in 467 ears and type ‘C’ pattern in 163 ears. Among 163 ears with type ‘C’ tympanogram, negative DPOAE results were seen in 96 ears. Group 4 (56/96) had a significant high rate of middle ear effusion than Group 3 (14/67) (p?Conclusions: DPOAE could be a great help in screening for middle ear effusion in patients with a type ‘C’ tympanogram.     

The pathology and clinical features of “glue ear”: a review

The clinical entity known as “glue ear” is synonymous with mucoid otitis media and represents the most common cause of hearing loss in children. This review considers the current state of our knowledge of mucoid otitis media, discussing definition and terminology, pathology, etiology and microbiology, clinical features, differential diagnosis and treatment. Received: 23 September 1999 / Accepted: 14 January 2000     

Expression of aquaporins mRNAs in patients with otitis media

Objective: This study analyzed the associations between measured levels of aquaporin (AQP) mRNAs and clinical manifestations in patients with various types of otitis media (OM).

Methods: AQP1, 2, 3, 4, 5, 6, 8, and 10 mRNA levels were assayed by real-time PCR from 57 patients with chronic otitis media (COM), 24 patients with cholesteatomatous otitis media (choleOM), and 82 patients with otitis media with effusion (OME). The relationships of these mRNA levels with the presence of bacteria, the type of hearing loss, and clinical manifestations of OM types were evaluated.

Results: All eight AQP mRNAs were expressed in inflammatory tissue, chole matrix, and effusion fluid obtained from all 163 patients with OM. The levels in OME of AQP2, 4, 6, and 10 mRNA; and the levels in choleOM of AQP1, 3, 4, and 10 mRNA were elevated significantly compared to the corresponding levels in COM (p?p?Conclusions: The levels of expression of AQP mRNA are associated with the pathophysiology of OM.