Study of mechanism of development in to the pars tensa cholesteatoma and sensory neural hearing loss in adhesive otitis media

动物研究：在咽鼓管鼓室口关闭和中耳腔粘膜受损的一组中观察到鼓膜粘连。在一些动物中，由于肉芽化而发生鼓膜粘连，而在其他动物中观察到薄鼓膜粘连。研究发现，中耳粘膜气体交换功能受损，以及咽鼓管通气不良，是鼓膜粘连的重要因素。分子生物学研究：表皮生长因子（EGF），EGF受体（EGF-R），和转化生长因子（TGF），其受体是EGF-用原位杂交方法研究了R的mRNA定位，采用各种组织的粘连性中耳炎。在炎性肉芽组织型中，上皮下炎性细胞浸润，EGF表达与中耳炎相似，EGF-R和TGF的表达也很强。因纳乔 ...更多信息 肉芽肿型和玻璃样变型上皮下炎性细胞缺失，EGF无表达，EGF-R和TGF弱表达。结果提示，当上皮下有活动性病变时，可进一步促进表皮增生，发展为中耳炎。中耳腔气体交换功能：粘连性中耳炎术后检查中耳压力及中耳腔气体交换功能。随着中耳粘膜的改善，中耳腔压力有升高的趋势，中耳腔产气功能逐渐恢复。但在广泛鼓室黏膜切除术后，由于中耳黏膜上皮化延迟，中耳腔压力增加不明显。咽鼓管功能：术后咽鼓管功能主要以声学方法研究。许多患者在手术前后的声学检查均为阳性。咽鼓管开放/闭合的持续时间不同，范围为100 msec至6000 msec。当比较术前和术后值时，未检测到明确的趋势。术后出现鼓膜再粘连的患者，术前咽鼓管狭窄者有之，而术前咽鼓管正常者有之，因此，根据术前咽鼓管功能很难作出准确的预后判断。少

Animal study : Tympanic adhesion was observed in a group in which the tympanic opening of the eustachian tube had been closed and the mucosa of the middle ear cavity had been damaged. Tympanic adhesion occurred as a result of granulation in some snimals, while adhesion of a thin tympanic membrane was seen in other animals. It was found that impaired gas exchange function of the middle ear mucosa, as well as poor ventilation of the eustachian tube, is an important factor of tympanic adhesion.Molecular biological study : Epidermal growth factor (EGF), EGF receptor (EGF-R), and transforming growth factor (TGF) whose receptor is EGF-R were studied with respect to localization of their mRNA by in situ hybridization method employing various tissues of adhesive otitis media. In the inflammatory granulation type, in which subepithelial inflammatory cell infiltration is seen, expression of EGF was similar to that seen with cholesteatoma, and expression of EGF-R and TGF was also strong. In fibro … More us granulation and hyalinization types, in which subepithelial layr inflammatory cells are absent, expression of EGF was not seen, and expression of EGF-R and TGF was weak. These findings suggest that, when there is active pathological changes in the subepithelial layr, epidermal proliferation may be further promoted, and cholesteatoma may be developed.Gas exchange function of middle ear cavity : Middle ear pressure and gas exchange function of the middle ear cavity were examined after operation for adhesive otitis media. As middle ear mecosa improved, middle ear cavity pressure tended to increase, and gas-generating function of the middle ear cavity recovered. However, in patients undergoing extensive removal of tympanic mucosa, increase in the pressure of the middle ear cavity tended to be poor because of delayd epithelization of middle ear mucosa.Eustachian tube function : Postoperative function of the eustachian tube was studied mainly based on the acoustic method. Many patients tested positive fot the acoustic test both before and after operation. Duration of time of open/closure of the eustachian tube differed, ranging from 100 msec to 6000 msec. When pre- and post-operative values were compared, no definite tendency was detected. In patients exhibiting re-adhesion of tympanic membrane postoperatively, preoperative eustachian tube was narrow in some cases, but it was normal in others, Hence, it is difficult to make accurate prognosis based on pre-operative eustachian tube function. Less