Efiology and Treatment of Recurrent Ofitics Media

中耳炎是上呼吸道感染中最常见的疾病之一。急性中耳炎（AOM）和渗出性中耳炎（OME）是一种自限性疾病，但有些病例反复复发。探讨AOM和OME的病因及其复发因素；特别是免疫和过敏症的预防。一项利用日本猴子和三维图像分析的动物模型研究显示，发生在鼓室的炎症迅速扩散到所有乳突空气细胞，产生炎症性液体，鼓室峡部和咽鼓管的炎症变化阻碍了液体的清除。发现中耳积液本身可诱发新的积液。因此，清除积液对于脑脊液的治疗至关重要。I型过敏不是病因。然而，鼻过敏引起的输卵管功能障碍。一项动物研究清楚地表明，鼻子的过敏反应会妨碍积液的清除。对中耳免疫应答的研究表明，由于免疫复合物的形成，全身免疫（循环抗体）是引起OME的一个因素，而粘膜免疫则具有抗炎作用。分泌抗肺炎链球菌和流感嗜血杆菌的IgA抗体活性阻止这些细菌附着在粘膜上。口服免疫诱导抗原特异性T抑制细胞抑制免疫介导性中耳炎的发生。一项实验研究表明，口服肺炎链球菌疫苗治疗可引起粘膜IgA反应，以预防肺炎球菌性中耳炎。结果提示口服肠胶囊预防中耳感染具有临床应用的可能性。

Otitis media is one of the most common diseases among upper respiratory tracts infections. Acute otitis media(AOM) and otitis media with effusion(OME) are a self limited disorder, but some cases recurrs repeatedly. We investigated causes of AOM and OME and these recurrence factors ; and the prevention in particular of immunologic and allergologic approach.1. An animal model study using Japanese monkey and three-dimensional images-analysis revealed that inflammation that occurs in the tympanic cavity rapidly spreads all over the mastoid air cells, producing inflammatory fluid and that inflammatory changes at the tympanic isthmus and eustachian tube block the clearance of fluid.2. it was found that middle ear effusion itself induces new effusion. Therefore, removal of the effusion in essential for the treatment of OME.3. The type I allergy is not an etiologic factor. However, allergic of the nose caused tubal dysfunction. An animal study clearly demonstrated that allergic reactions of the nose disturb the clearance of effusion.4. Investigation on the immune response of the middle ear showed that the systemic immunity (circulating antibodies) is a causative factor for OME because of the formation of immunocomplex, while the mucosal immunity acts as anti-inflammatory agent. Secretory IgA antibody activity against S. pneumoniae and H. influenza blocked the attachment of these bacteria to the mucosal membrane.5. Oral immunization induced antigen specific T suppressor cells that suppress the occurrence of immune-mediated otitis media.6. It was demonstrated by an experimental study that oral vaccine therapy with S. pneumoniae elicits mucosal IgA responses to prevent pneumococcal otitis media. Results suggested the possibility of clinical application of oral vaccination by enteric capsules for the prevention of middle ear infection.