腺样体手术治疗儿童分泌性中耳炎的临床疗效观察

目的:观察腺样体手术治疗儿童分泌性中耳炎的临床效果。方法:选择分泌性中耳炎合并腺样体肥大患儿80例(160耳),将其随机分为手术组和对照组,每组40例,手术组患儿给予腺样体消融手术治疗,而对照组患儿进行保守治疗,观察和比较两组治疗1个月后的临床疗效。结果:治疗1个月后,手术组治愈72耳,好转6耳,治疗总有效率为97.5%,而对照组治愈8耳,好转20耳,治疗总有效率为35%,较手术组显著降低(P0.05)。结论:腺样体切除是治疗分泌性中耳炎的有效途径,治疗中应尽可能避免并发症的发生,恢复和保护咽鼓管的生理功能。     

腺样体手术治疗儿童分泌性中耳炎的临床疗效观察

目的：观察腺样体手术治疗儿童分泌性中耳炎的临床效果。方法：选择分泌性中耳炎合并腺样体肥大患儿80例（160耳）,将其随机分为手术组和对照组,每组40例,手术组患儿给予腺样体消融手术治疗,而对照组患儿进行保守治疗,观察和比较两组治疗1个月后的临床疗效。结果：治疗1个月后,手术组治愈72耳,好转6耳,治疗总有效率为97．5％,而对照组治愈8耳,好转20耳,治疗总有效率为35％,较手术组显著降低（P〈0．05）。结论：腺样体切除是治疗分泌性中耳炎的有效途径,治疗中应尽可能避免并发症的发生,恢复和保护咽鼓管的生理功能。     

腺样体肥大儿童鼻咽部细菌培养结果分析

目的研究腺样体肥大儿童的鼻咽部细菌携带情况。方法 2013年3月至2014年3月期间对因腺样体肥大而入院手术的127例3~14岁儿童进行鼻咽部细菌培养,分为两组,第一组为单纯腺样体肥大伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)共34例,第二组为腺样体肥大伴OSAHS并且合并鼻窦炎、中耳炎的患儿共93例,对结果进行分析比较。结果 127例腺样体肥大儿童鼻咽拭子细菌检出率为84.3%,第一组为76.5%,第二组为87.1%,细菌的检出率与患者的临床症状有相关性,伴有中耳炎和慢性鼻窦炎的患儿细菌检出率更高。经χ2检验,两组儿童鼻咽部腺样体细菌培养阳性率比较差异有统计学意义(χ2=127,P0.05)。结论 3~14岁腺样体肥大儿童鼻咽部条件致病菌携带率较高,特别是伴有慢性鼻窦炎或中耳炎的患儿,通过研究结果可对患儿后期治疗提供病原学依据,并对儿童腺样体肥大及相邻器官感染性疾病的预防和控制具有积极的意义。     

分泌性中耳炎临床治疗文献综述

分泌性中耳炎（secretory otitis media,SOM）是耳鼻喉科常见病、多发病,它是以鼓室积液及听力下降为主要特征的中耳非化脓性疾病,又名非化脓性中耳炎、卡他性中耳炎、渗出性中耳炎、浆液性中耳炎、黏液性中耳炎、胶耳等。其发生与咽鼓管功能异常、中耳黏膜气体交换功能及乳突气化功能不良、咽鼓管表面活性物质缺乏、感染、免疫、     

分泌性中耳炎大鼠咽鼓管鼓室β-防御素的表达

目的检测大鼠β防御素(ratβ-defensin,rBD)在分泌性中耳炎大鼠咽鼓管鼓室的表达,探讨β防御素在分泌性中耳炎发病机制中的作用。方法排除中耳感染的清洁级SD大鼠48只,随机分为4组,前3组36只行颈部切口经右侧听泡注入脂多糖(lipopolysaccharide,LPS)溶液(1mg/mL)30μL制作分泌性中耳炎动物模型,造模后分别于第1、3、7天断头取咽鼓管鼓室黏膜;对照组12只右侧听泡注入生理盐水30μL,左侧听泡作为正常组,3d后断头取咽鼓管鼓室黏膜。逆转录聚合酶链反应(RT-PCR)检测咽鼓管鼓室rBD-1mRNA和rBD-2mRNA的表达。结果正常大鼠咽鼓管鼓室存在rBD-1和rBD-2的表达,且rBD-1的表达较rBD-2强,差异有统计学意义;造模后第1、3、7天,rBD-1表达变化不明显;rBD-2则在造模后第1、3天明显增加,差异有统计学意义,第7天渐回复到正常水平。结论在大鼠,rBD-1可能参与正常咽鼓管鼓室的防御功能,造模后rBD-2的表达增加可能与病原体入侵后的清除相关。     

儿童腺样体肥大的X 线表现

总结儿童腺样体肥大的X线表现。在本组1263例腺样体肥大中：男女比例1．45：1,均摄鼻咽侧位平片。采用A/N比值阅片;其中打鼾78%,张口呼吸2%,鼻塞8%,反复咽痛1%,中耳炎4%,扁桃体Ⅰ～Ⅱ°肿大6%;4～10岁的发病率较高,约占总数的58．9%。本组A/N比值：0．50～0．60者173例(13．7%),0．61～0．70者644例(51．0%),0．71者446例(35．3%)。A/N比值≤0．60属正常范围,0．61～0．70为中度肥大,≥0．71为病理性肥大。摄吸气期的鼻咽侧位平片是观察腺样体肥大的简单而准确的方法,同时测定A/N比值用以观察腺样体的厚度,腺样体肥大者的X线表现为：鼻咽侧位平片可见后壁软组织突出影使气管呈弧形压迹,压迹表面光滑,压迹范围小,周围骨组织无破坏,软组织突出影密度均匀一致。还需与咽后壁脓肿、咽部肿瘤等疾病鉴别。     

手术治疗摩洛哥儿童睡眠呼吸障碍的临床研究

目的:观察鼻内镜下腺样体切除术或联合扁桃体切除术对摩洛哥儿童睡眠呼吸障碍的疗效,探讨儿童睡眠呼吸障碍治疗的手术适应症。方法:136例病例分成2组,治疗组85例睡眠呼吸障碍伴慢性扁桃体炎、或扁桃体Ⅲ°肥大的儿童,行鼻内镜下腺样体切除加扁桃体切除术;对照组51例睡眠呼吸障碍伴单纯扁桃体扁桃体Ⅱ°肥大的儿童,采用鼻内镜下腺样体切除,术后随访3个月。结果:治疗组总有效率为100%(85/85),对照组84.31%(43/51),差异有统计学意义(P0.05);两组患儿的Conners儿童行为量表评分较术前明显下降,差异有统计学意义(P0.05)。结论:鼻内镜下腺样体切除术联合扁桃体切除术,明显改善患儿睡眠和呼吸,生活质量明显提高,是治疗摩洛哥儿童睡眠呼吸障碍的一线治疗方案。     

耳内镜与显微镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎的疗效比较及术后短期内听力恢复效果的影响因素分析

摘要 目的：比较耳内镜与显微镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎的疗效,并分析术后短期内听力恢复效果的影响因素。方法：选取2019年3月~2022年2月期间我院收治的158例慢性化脓性中耳炎患者,均接受Ⅰ型鼓室成形术治疗,根据手术方式不同分为耳内镜组（81例）和显微镜组（77例）,比较两组临床疗效及术后6个月的听力恢复不良发生率。收集相关资料,采用多因素Logistic回归分析术后短期内听力恢复效果的影响因素。结果：两组鼓膜穿孔发生例数组间对比无统计学差异（P>0.05）。耳内镜组的手术时间、住院时间短于显微镜组,术中出血量、医疗费用、干耳时间>1个月例数、耳廓麻木发生例数少于显微镜组（P<0.05）。耳内镜组、显微镜组术后6个月的听力恢复不良发生率组间对比无统计学差异（P>0.05）。单因素分析结果显示,慢性化脓性中耳炎患者术后6个月听力恢复效果与鼓室黏膜、鼓膜张肌腱、咽鼓管情况、是否鼓室硬化、听小骨周围是否肉芽包裹、术前鼓室内是否有脓性分泌物有关（P<0.05）。多因素Logistic回归分析显示,鼓膜张肌腱缺损、咽鼓管不通、鼓室硬化、听小骨周围肉芽包裹、术前鼓室内有脓性分泌物是慢性化脓性中耳炎患者术后短期内听力恢复不良的危险因素（P<0.05）。结论：与显微镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎相比,耳内镜下进行手术可缩短手术时间、住院时间,减少术中出血量和住院费用,降低并发症发生率。此外,患者术后短期内听力恢复效果受到鼓膜张肌腱、咽鼓管、鼓室硬化、听小骨周围肉芽包裹、术前鼓室内脓性分泌物等多种因素的影响。     

围术期应用黏液促排剂治疗中耳炎疗效初步观察与评估

目的:探讨中耳炎围术期应用黏液促排剂临床效果。方法:本次选取中耳炎患者80例,均为我院耳鼻喉科2013年5月至2015年5月收治,随机分组,就常规手术(对照组,n=40)与围术期取黏液促排剂应用(观察组,n=40)效果展开对比。结果:观察组分泌性中耳炎、慢性化脓性中耳炎咽鼓管功能恢复有效率均高于对照组(P0.05),胆脂瘤型中耳炎恢复情况组间无差异(P0.05)。观察组主观症状恢复有效率为95%,明显高于对照组80%(P0.05)。结论:中耳炎围术期采用黏液促排剂治疗,可促咽鼓管功能改善,提高临床治疗效果,有重要的推广应用价值。     

三种腺样体手术方式治疗儿童OSAHS的临床观察

目的:探讨三种腺样体手术方式治疗儿童OSAHS临床疗效.方法:对86例经多导睡眠监测(PSG)确诊的OSAHS患儿(3-12岁)施行:全麻下经鼻内镜经口-鼻腺样体切除术、内镜辅助下射频消融术及传统的经口腺样体刮除术3术式,并对患儿进行术后的随访,观察术后夜间打鼾、鼻塞、张口呼吸等临床症状、腺样体残留等指标.结果:术后随访6-12个月.鼻内镜术后打鼾、鼻塞、张口呼吸等症状治愈率显著高于传统的腺样体刮除术(P＜0.01).传统的腺样体刮除术、鼻内镜下腺样体微波消融术,存在不同比例的腺样体残留,鼻内镜经口-鼻腺样体切除术,无腺样体残留.结论:手术切除肥大的腺样体是治疗儿童OSAHS的主要手段.鼻内镜辅助下腺样体切除术具有直视下操作、病变切除彻底、疗效明显、安全性高、创伤小及并发症少等优点.     

The structure of the middle ear epithelium of the rat and the effect of Eustachian tube obstruction

Summary The middle ear cavity of the rat is lined with ciliated and squamous epithelium. The arrangement of the ciliated cells, interspersed with secretory cells, in distinct tracts and their continuity with the ciliated epithelium of the Eustachian tube, suggests the existence of a mucociliary transport system for cleaning the middle ear cleft. The secretory cells produce either neutral or sulphated glycoproteins, dependent on their location. In addition to these secretions, the epithelium of the lower part of the Eustachian tube is bathed with secretory products of seromucous glands.Also in the areas with squamous epithelium, numerous small secretory cells, the character of which is only identifiable with the electronmicroscope, are present. It is concluded that the middle ear lining can be considered as a locally modified respiratory epithelium.Blockade of the mucociliary transport system, supposedly a crucial aetiological factor in secretory otitis media, by obstruction of the Eustachian tube, induces pathogenic behaviour of microorganisms normally present in the middle ear. This results in either a transient or a longstanding infective middle ear disease, associated with a large variety of changes of the mucosa, especially with respect to the secretory activity.The data obtained indicate that the increased secretory activity encountered in secretory otitis media cannot be attributed to the isolated effect of tubal occlusion, but rather to an infective process.     

Characterization of mucins in human middle ear and Eustachian tube

Mucins are important glycoproteins in the mucociliary transport system of the middle ear and Eustachian tube. Little is known about mucin expression within this system under physiological and pathological conditions. This study demonstrated the expression of MUC5B, MUC5AC, MUC4, and MUC1 in the human Eustachian tube, whereas only MUC5B mucin expression was demonstrated in noninflamed middle ears. MUC5B and MUC4 mucin genes were upregulated 4.2- and 6-fold, respectively, in middle ears with chronic otitis media (COM) or mucoid otitis media (MOM). This upregulation of mucin genes was accompanied by an increase of MUC5B- and MUC4-producing cells in the middle ear mucosa. Electron microscopy of the secretions from COM and MOM showed the presence of chainlike polymeric mucin. These data indicate that the epithelium of the middle ear and Eustachian tube expresses distinct mucin profiles and that MUC5B and MUC4 mucins are highly produced and secreted in the diseased middle ear. These mucins may form thick mucous effusion in the middle ear cavity and compromise the function of the middle ear.     

上鼓室重建对慢性中耳炎开放式鼓室成形术作用的临床研究

目的：观察在开放式鼓室成形术中,重建上鼓室对慢性中耳炎治疗的临床疗效。方法：86例（86耳）慢性中耳炎患者随机均分两组：两组均行开放式鼓室成形术,其中实验组应用自体乳突骨粉联合耳后肌骨膜瓣缩窄乳突根治腔,并垫高上鼓室内壁;对照组不行乳突根治腔缩窄术。回顾性观察两组患者在鼓膜状态（内陷及穿孔）、干耳时间、听力提高,头晕头痛、肉芽增生等几个方面的恢复情况。结果：通过对两组病例进行随访和疗效分析,在鼓膜状态、干耳时间、头晕头痛等方面,其临床疗效差异有显著性（P〈0．05）;而在术后听力提高及肉芽增生方面无显著性差异（P〉0．05）。结论：在慢性中耳炎开放式鼓室成形术中,自体材料的应用缩短了千耳时间、提高了手术疗效,减少了手术相关的并发症。     

外耳道胆脂瘤30例临床分析（英文）

目的：探讨外耳道胆脂瘤的临床特征和最佳治疗方法,提高临床诊治水平。方法：回顾性分析30例（32耳）外耳道胆脂瘤患者的临床资料。12耳病变局限于外耳道无明显骨质破坏,经耳内窥镜下行胆脂瘤清除病术;10耳病变局限于外耳道,但有较广泛的骨质破坏或有外耳道口狭窄者,经耳内切口显微镜下清除病变并加行外耳道成形术;10耳病变侵及鼓室或乳突,在显微镜下经耳后切口行乳突根治术。有条件者行乳突根治术加鼓室成形术。结果：本组病例所有患者术后病理均为胆脂瘤。术后外耳道口保持宽大,外耳道皮肤恢复正常,不产生上皮堆积。随访1年以上胆脂瘤无复发。结论：耳内镜与显微镜配合应用可彻底清除胆脂瘤,防止胆脂瘤残留和复发,并能提高听力.     

Ectopic mineralization in the middle ear and chronic otitis media with effusion caused by RPL38 deficiency in the Tail-short (Ts) mouse

Inflammation of the middle ear cavity (otitis media) and the abnormal deposition of bone at the otic capsule are common causes of conductive hearing impairment in children and adults. Although a host of environmental factors can contribute to these conditions, a genetic predisposition has an important role as well. Here, we analyze the Tail-short (Ts) mouse, which harbors a spontaneous semi-dominant mutation that causes skeletal defects and hearing loss. By genetic means, we show that the Ts phenotypes arise from an 18-kb deletion/insertion of the Rpl38 gene, encoding a ribosomal protein of the large subunit. We show that Ts mutants exhibit significantly elevated auditory-brain stem response thresholds and reduced distortion-product otoacoustic emissions, in the presence of normal endocochlear potentials and typical inner ear histology suggestive of a conductive hearing impairment. We locate the cause of the hearing impairment to the middle ear, demonstrating over-ossification at the round window ridge, ectopic deposition of cholesterol crystals in the middle ear cavity, enlarged Eustachian tube, and chronic otitis media with effusion all beginning at around 3 weeks after birth. Using specific antisera, we demonstrate that Rpl38 is an ～8-kDa protein that is predominantly expressed in mature erythrocytes. Finally, using an Rpl38 cDNA transgene, we rescue the Ts phenotypes. Together, these data present a previously uncharacterized combination of interrelated middle ear pathologies and suggest Rpl38 deficiency as a model to dissect the causative relationships between neo-ossification, cholesterol crystal deposition, and Eustachian tubes in the etiology of otitis media.     

Computed tomography in the diagnosis of exudative otitis media

Temporal bone computed tomography (CT) was used to examine 37 patients aged 2 to 55 years who had exudative otitis media; in 27 patients of them, a pathological process was bilateral. An analysis of 58 temporal bone CT scans identified the CT signs of chronic exudative otitis media. These included a partial or complete block of the osseous foramen of the auditory tube; impaired pneumatization of the tympanic cavity, mastoid process fenestrae, and antrum; pathological drawing-in of the tympanic membrane. The preservation of the auditory ossicles and the absence of destructive changes in the walls of the cavities of the middle ear were observed in most cases. Repeated temporal bone CT study was performed in 10 patients (14 temporal bones) in different periods (from 2 months to 3 years) after surgery. The results of tympanostomy were visually assessed. These included recovered pneumatization of middle ear cavities (7 temporal bones), a cicatricial process in the tympanic cavity (5 temporal bones), recurrence of the CT manifestations of exudative otitis media (2 temporal bones).     

化脓性中耳炎病原菌感染的研究进展

化脓性中耳炎是耳鼻喉科临床常见疾病,可导致听力下降、鼓膜充血、鼓膜穿孔、耳鸣、耳痛及流脓等。化脓性中耳炎主要由微生物进入中耳引起感染,使中耳黏膜发生化脓性病变,且不同患者感染的病原菌不同。本文从化脓性中耳炎的发病机制、病原菌及其耐药性和治疗方法等几个方面进行综述,以期为临床化脓性中耳炎的诊断及合理用药提供参考。