Pathogenesis of adhesive otitis media and pars tensacholesteatoma

鼓膜缩回袋中碎片的积累和感染的发展，然后碎片中细胞因子的积累产生，主要是IL-1？已被引用为胆脂瘤进展的机制。此外，部分表皮屏障机制受损，包括胆脂瘤上皮角质层的丢失，更容易受到感染的影响。上皮下成纤维细胞和单核细胞也受到来自鳞状上皮一侧的刺激，由于上皮下层细胞间隙的打开和基底膜的部分结构改变，表皮肥大。此外，据推测胆脂瘤的进展是炎症的负面环境的结果，在炎症环境中，由于细胞因子网络的参与，表皮和表皮下组织之间的串扰诱导表皮生长。更值得注意的是，有研究认为胆脂瘤上皮下的成纤维细胞可能具有诱导表皮细胞生长和延长炎症的作用。也有假设认为凋亡只发生在胆脂瘤的生长部分，然而，与分化或细胞死亡相关的结构没有破坏。具有生理功能的粘膜上皮的早期再生是影响手术效果的重要因素。人工制造的三维粘膜上皮培养实验和动物粘膜移植实验显示，mucin基因在人工粘膜中表达，提示基底膜的形成和粘液的产生，人工粘膜在形态和功能上都与中耳粘膜相似。此外，将自体细胞生成的三维粘膜上皮移植到外露骨表面，可导致粘膜形态的早期再生，并且在气体交换能力的研究中发现其维持生理功能。临床应用前景广阔。少

Accumulation of debris in the eardrum retraction pocket and development of infection in it, and then accumulation in the debris of cytokines produced, primarily IL-1?, has been cited as the mechanism of progression of cholesteatomas. In addition, part of barrier mechanisms of the epidermis is damaged, including loss of the corneum in the epitheliuni of cholesteatomas, and it becomes more susceptible to the effects of the infection. Subepithelial fibroblasts and mononuclear cells are also stimulated by stimuli from the squamous epithelium side, and the epidermis hypertrophies as a result of opening of the intercellular spaces in the subepidermal layer and the partial structural changes in the basement membrane. Moreover, it is postulated that cholesteatomas progress as a result of the negative environment of the inflammation in which epidermal growth is induced by cross-talk between the epidermis and the subepidermal tissue due to involvement of the cytokine network. It is particularly … More noteworthy that it has been suggested that the fibroblasts under the epithelium of cholesteatomas may have the role of inducing epidermal cell growth and prolongation of the inflammation. It has also been postulated that apoptosis occurs only in the growing portion of cholesteatomas, however, there is no breakdown in the structures related to differentiation or cell death.Early regeneration of mucosal epithelium that possesses-physiological functions is an important factor governing the results of surgery. Culture experiments with artificially produced 3-dimensional mucosal epithelium and mucous membrane graft experiments in animals have revealed expression of the mucin gene in artificial mucosa, suggesting the formation of a basement membrane and mucus production, and the artificial mucosa has been shown to resemble the middle ear mucosa in vivo, both morphologically and functionally. Moreover, graft of 3-dimensional mucosal epithelium produced from autologous cells onto the surface of exposed bone resulted in early regeneration of mucosal morphology, and in a study of gas exchange capacity it was found to maintain physiological function. Clinical application is expected in the future. Less