Pathogenesis and Managements for Chronic Secretory Otitis Media.

1)我们的流行病学研究显示，有急性中耳炎、鼻窦病变和腺样体增生史的儿童发生分泌性中耳炎的相对危险性显著高。结果表明，中耳及上呼吸道的急性和慢性炎症与SOM的发病有关。2)研究中耳积液中花生四烯酸酯的代谢，以阐明介导SOM炎症反应的因素。儿童中耳积液中前列腺素（PG） E_2、F_<2alpha>、6-酮- pgf_ <2alpha>的浓度均高于成人。积液中的炎症细胞在儿童中也较多。3)不同年龄组（儿童和成人）中耳粘膜超微结构检查显示，中耳内膜粘膜无明显差异。4)对90只中耳积液患者行中耳通气管置入治疗。VT插入后，采用鼓室测量中耳空气量（MEAV）。结果发现，MEAV小于1.5 ml的中耳积液复发率很高。5)我们试图评价康坡药治疗SOM的疗效。本研究选用赛雷托（TJ-114）作为心房药物，它含有12种从各种植物和蔬菜中提取的基本干提取物，并通过实验室动物实验证明具有抗炎和抗过敏作用。目前的初步公开试验研究显示，TJ-114在8.7%的耳外完全消退，19.6%的耳外显着改善。21.7%患者无改善。

1) Our epidemiologic studies revealed that the relative risk for secretory otitis media was significantly high in children who had the histories of acute otitis media, sinus troubles and adenoids vegetation. This results suggest that acute and chronic inflammation of the middle ear as well as the upperrespiratory tract is responsible in the onset of SOM.2) Arachidonate metabolism in the middle ear effusion was studied to clarify factors mediating inflammatory responses in SOM. The concentrations of prostaglandin (PG) E_2, F_<2alpha>, and 6-keto-PGF_<2alpha> were higher in the middle ear effusions of children than in those of adults. The inflammatory cells in the effusion were also more numerous in the children. These results suggest that inflammatory reactions are more accelerated in the children's SOM.3) Ultrastructural Examinations of the middle ear mucosa from two different age groups (children and adults) revealed no significant differences in the lining mucosa of the middle ear.4) Ninety ears with middle ear effusions were treated by insertion of a ventillation tube (VT) insertion. Following VT insertion, the middle ear air volume (MEAV) was measured by tympanometry. It was found that very high recurrence rate of the middle ear effusions was seen in the ears with small MEAV less than 1.5 ml.5) We attempted to assess the efficacy of Kampo-medicine in SOM. Sairei-to (TJ-114) was chosen as atrial medicine which contains 12 basic dry extracts from various plants and vegetalbes and which has been proven to have anti-inflammatory and anti-allergic effects through animal experiments in the laboratory. The present preliminary open trial study revealed that TJ-114 brought complete resolution in 8.7% out of ears and significant improvement in 19.6%. No improvement was found in 21.7%.