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。我们调查了AOM和OME的原因和这些复发因素;以及特别是免疫学和变态反应学方法的预防。一项使用日本猴的动物模型研究和三维图像分析显示，鼓室内发生的炎症迅速扩散到乳突气室，产生炎性液体，而鼓室峡部和咽鼓管的炎性变化阻碍了液体的清除.发现中耳积液本身引起新的积液。因此，清除渗出液是治疗OME的关键。I型变态反应不是致病因素。然而，鼻子过敏引起输卵管功能障碍。一项动物研究清楚地表明，过敏反应的鼻子干扰清除积液。4.对中耳免疫反应的研究表明，全身免疫（循环抗体）是OME的致病因素，因为形成免疫复合物，而粘膜免疫起抗炎作用。分泌型伊加抗体活性。pneumoniae和H.流感阻断了这些细菌对粘膜的附着。口服免疫诱导抗原特异性T抑制细胞，抑制免疫介导的中耳炎的发生.实验研究表明，口服疫苗治疗S。肺炎球菌激发粘膜伊加反应，预防肺炎球菌性中耳炎。结果提示，口服肠溶胶囊预防中耳炎的临床应用是可行的。

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.