Experimental studies of prevention and therapy in intractable otitis media

临床症状和耳镜这种增加的炎症水平在IN接种NTHi后又持续了7天，之后鼓膜炎症评分平均增加到2+，表明中度炎症，存在或怀疑有渗出。当研究结束时，这种炎症水平一直维持到接种NTHi后的第14天。粘附性NTHi的数量在接种IN后4天，ET咽部黏附在地板粘液上的平均数量明显多于接种后1天。在接下来的10天的观察中，咽底粘液的粘附率继续略有增加。在ET的中部和鼓室，NTHi黏附于地面黏液的数量逐渐增加，直到第14天才达到最大值。在所指示的天数中，NTHi黏附在屋顶黏液上的数量显著少于黏附于地面黏液的黏附数量。在本研究的所有时间点，在ET的任何部分(咽、中、鼓室)或区域(顶部、底部)，NTHi黏附于粘膜上皮细胞的数量可以忽略不计。NTHi黏附在中耳黏膜上的数量很少，直到接种后约7-10天，此时通过耳镜和鼓室导纳测定也有OM的临床症状，如上文所示。在电子显微镜下，NTHi嵌入到ET腔内的粘液中，在睫状尖深度以下没有观察到，也没有看到它们附着在ET任何间隔的任何一种上皮细胞的表面

Clinical signs and otoscopyThis increased level of inflammation was sustained for an additional 7days post-IN inoculation of NTHi, after which the mean tympanic membrane inflammation score increased to value of 2+ indicating moderate inflammation with an effusion present or suspected. This level of inflammation was maintained to day 14 after NTHi inoculation when the study was terminated.Quantitation of adherent NTHiThe mean number of NTHi adherent to floor mucus at the pharyngeal portion of the ET was significantly greater 4 days after IN inoculation than at one day post inoculation. Adherence to pharyngeal floor mucus continued to increase slightly over the remaining 10 days of observation. At the mid and tympanic portions of the ET, the number of NTHi adherent to floor mucus increased more gradually, not reaching a maximum value until day 14.NTHi adherence to roof mucus was significantly less than to floor mucus at all three portions of the ET on the days indicated. The number of NTHi adherent to cells of the mucosal epithelium in any portion (pharyngeal, mid, tympanic) or region (roof, floor) of the ET was negligible at all time points of this study.NTHi adherence to middle ear mucosa was minimal until approximately 7-10 days after inoculation when there were also clinical signs of the onset of OM as determined by both otoscopy and tympanometry and delineated above. This increase in mean adherent bacteria was significantly between days : 4 and 7 ; and 7 and 10 days.Electron microscopyNTHi were found embedded in the mucus in the ET lumen and were not observed below the depth of the ciliary tips nor were they seen adherent to the surface of any epithelial cell type in any compartment of the ET