Studies of proliferating and ingibiting factors to the transformation from infant secretory otitis media to cholesteatoma

获得性胆脂瘤起源于慢性婴儿分泌性中耳炎（SOM）的后遗症，分为松弛型和tenza型两类。这些研究的目的是阐明促进或阻止胆脂形成的因素。接下来的研究是为了达到这个目的。术中对胆脂瘤基质进展情况的详细观察，SOM患者的长期随访，炎性颞骨尤其是硬化性乳突骨的形态学研究。中耳、乳突粘膜分泌腺的盛衰、胆脂瘤表皮细胞及基质的培养研究、表皮细胞生长因子的研究、耳膜超微结构的研究。根据这些研究的结果，分泌性中耳炎（SOM）向胆脂瘤发展的促进因素可以解释如下。输卵管功能不足，乳突空气细胞系统受到抑制，乳突空气流通受阻。此外，持续轻度炎症、负压、鼓膜表皮生长因子等均是胆脂瘤发生的促进因素。胆管部纤维消失和鼓膜粘连是促进胆管胆脂瘤发生发展的重要机制。另一方面，阻止胆脂瘤发展的必要条件是：早期改善输卵管功能，特别是在儿童时期，抑制乳突再气化，鼓室穿孔的发生和防止粘连。从这些后果来看，插入通气管治疗慢性分泌性中耳炎是理想的治疗方法。

The acquired cholesteatoma originats from sequela of chronic infant secretory otitis media(SOM) and is diveded into two categories, that is flaccida type and tenza type. The purpose of the studies are that elucidate the factors which promote or prevent the development of cholesteatomaNext studies were performed to accomplish this aim. Detailed observation for the advance of cholesteatoma matrix during surgeries, long term following up to the patients with SOM, morphological study of inflammatory temporal bone especially of sclerotic mastoid.Prosperity and decay of secretory glands of mucose membrane of the middle ear and mastoid, culture study of epedermal cells and matrix of cholesteatoma, besides study of prowth factors to the epidermal cell, ultrastructure of the ear drum of SOM.As the results of these studies, the promoters of progression from secretory otitis media(SOM) to cholesteatoma can be explained as follows. Deficiency of tubal function, suppressed air cell system of mastoid and blockage of aeration to the mastoid. Besides, continuance of slight inflammation, negative pressure, growth factors to the epidermis of tympanic membrane in the attic are promoting factors to cholesteatoma. Further, disappearance of fibers in pars tneza and adhesion of tympanic membrane are important mechanism to promote the developmnet of tenza cholesteatoma.On the other hand, the essential conditions for arresting the development to cholesteatoma are as follows, early improvement of tubal function especially at the age of childhood, re-pneumatization of suppressed mastoid, occurrence of tympanic perforation and prevention of adhesion. From these consequences insertion of ventilation tube to the chronic secretory otitis media is ideal procedure.