RELATIONSHIP BETWEEN INSUFFICIENCY OF TRNSMUCOSAL GAS EXCHANGE AND REFRACTORINESS OF MIDDLE EAR INFLAMMATORY DISEASE-EXPERIMENTAL AND CLINICAL STUDY.

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Mucosal lesion in the middle ear pneumatic space is closely related to the suppression of pneumatization. A transmucosal gas exchange function is clearly present in the mucosal epithelium of the middle ear pneumatic space. In persistent middle ear inflammation as represented by OME, the subepithelial layer of the middle ear mucosa is damaged, and the gas exchange function, mainly of diffusion of COィイD22ィエD2, is suppressed. Change in the TP in the middle ear cavity observed in patients with indwelt tube is also thought to be related to this gas exchange function ; the peak value of the TP had was lower in patients with severer mucosal lesion. In these patients, the peak value of the TP had increased after 18 or more months of tube indwelling, when the mucosa of middle ear cavity seemed to be recovered normal thin mucosa. This mucosal normalization was especially important in subepithelium because of thin layer with many capillary networks. This subepithelial mucosal normalizaiton was also confirmed by the repneumatization of the mastoid cell after two years of treatment. Therefore, it is assumed that the intractability of OME with suppressed mastoid cells is affected by the insufficiency of transmucosal gas exchange function, so the transmucosal gas exchange is involved in the on set and healing process of middle ear mucosal disease when it seems likely that normalization of transmucosal gas exchange function follows resolution of middle ear inflammation and the subsequent mucosal inflammation, and it is possible to estimate the severity of mucosal lesion by measuring the peak value of the TP.