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，但有些病例会反复复发。我们调查了AOM和OME的原因以及这些复发因素；特别是免疫学和过敏学方法的预防。一项使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蔓延到整个乳突气细胞，产生炎症液体，鼓峡部和咽鼓管的炎症变化阻碍了液体的清除。研究发现，中耳积液本身也会引起新的积液。因此，清除积液是治疗OME的关键。I型过敏不是病因。然而，鼻子过敏会导致输卵管功能障碍。一项动物研究清楚地表明，鼻子的过敏反应扰乱了积液的清除。对中耳免疫反应的研究表明，由于免疫复合体的形成，全身免疫(循环抗体)是OME的致病因素，而粘膜免疫则起到抗炎作用。针对肺炎链球菌和流感嗜血杆菌的分泌型IgA抗体活性阻断了这些细菌在粘膜上的附着。口服免疫诱导抗原特异性T抑制细胞抑制免疫介导性中耳炎的发生。一项实验研究表明，肺炎链球菌口服疫苗可引起粘膜免疫球蛋白A反应，从而预防肺炎链球菌性中耳炎。提示口服疫苗肠溶胶囊预防中耳感染的临床应用的可能性。

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.