ET Growth and Development: Anatomy/Function

咽鼓管生长发育的解剖学/功能 现有的文献证明咽鼓管在发病机制和/或 中耳炎的持久性(OM)。横断面研究报告年龄较大的儿童OM患病率较低， 年龄较大的儿童ET压力调节功能较好，ET形态、长度和宽度的年龄差异， 以及输卵管旁肌肉系统的矢量方向。这些与生长相关的ET结构变化 关系明显地预示着日益有效的ET函数(F)，并且因为ET和 输卵管旁肌肉与颅底关系密切，ET系统的矢量方向可为 根据骨学或放射学数据重建的。总而言之，这些观察结果表明， ET-输卵管旁肌肉向量关系的年龄相关变化反映在更有效的ETF中，并通过 结果，OM风险降低。拟议纵向研究的总体目标是评估 这一假设的真实性。我们计划招收90名2-3岁的儿童(有病史的1-30组 复发的急性OM组，有渗出性OM病史的11-30组，以及对照组111-30组)，并评估 ETF(每年)和测量颅面形态(通过每年一次的人体测量、每两年一次的头影测量、 4岁和6岁的子集)，为期5年。颅面测量将被用于重建向量 每个孩子的ET系统的关系，并将与ETF结果一起提交给Core C，用于 分析颅面形态对ETF的限制背后的翻译机制。 这些数据将被用来检验以下假设：1)某些头面部测量数据 形态预测OM风险增加；2)这些测量的对应关系由非侵入性表示 人体测量；3)ETF变量区分OM的不同临床表现；4) ET的机械性能受颅面骨骼的基本形式/结构的限制，以及 5)头面部骨骼的生长发育与更有利的ET/输卵管旁肌肉有关 向量关系，然后反映在更好的ETF测试结果中。在这些孩子的子集(10个/组)中 选择他们的能力是因为他们能够在没有安放的情况下完成MRI测试，ET-ME系统的MRI将在 4岁和6岁。数据将被用来重建系统的功能机制，以供比较 在不同组之间，以及由颅面测量产生的各自的力学。本项目 代表了将过去的观察性研究转化为纵向临床研究，这将是第一次， 测试那些早期结果所提出的可证伪假设。研究结果可能会导致发展和 早期识别OM高危儿童及判断病程预后方法的应用 在幼儿中，以及针对特定患者的替代干预措施，以预防/治愈OM。

EUSTACHIAN TUBE GROWTH AND DEVELOPMENT: ANATOMY/FUNCTION The existing literature documents an important role for the Eustachian tube (ET) in the pathogenesis and/or persistence of Otitis Media (OM). Cross-sectional studies report a lower prevalence of OM in older children, a better ET pressure-regulating function in older children and age-related differences in ET form, length and width, and the vector orientation of the paratubal musculature. These growth-related changes in ET structural relationships are demonstrably predictive of increasingly more efficient ET function (F) and, because the ET and paratubal musculature are intimately related to the cranial base, the vector orientation of the ET system can be reconstructed from osteological or radiographic data. Together, these observations suggest that measurable, age-related changes in ET-paratubal muscle vector relationships are reflected in more efficient ETF and, by consequence, a decreased OM risk. The overall goal of the proposed longitudinal study is to evaluate the validity of this hypothesis. We plan to enroll a total of 90 children at 2 to 3 years of age (Group 1-30with a history of recurrent actute OM, Group 11-30 with a history of OM with effusion, and Group 111-30 control) and to evaluate ETF (yearly) and measure craniofacial morphology (by yearly anthropometry, biyearly cephalometrics, MRI in a subset at age 4 and 6) over a 5 year period. The craniofacial measures will be used to reconstruct vector relationships of the ET system for each child and will be submitted along with the ETF results to Core C for analysis of the translational mechanism underlying the limitations imposed on ETF by craniofacial morphology. These data will be used to test the following hypotheses: 1) certain cephalometric measures of craniofacial morphology predict increased OM risk; 2) correspondences to these measures are represented by non-invasive anthropometric measures; 3) ETF variables discriminate between the different clinical presentations of OM; 4) the mechanical properties of the ET are limited by the underlying form/structure of the craniofacial skeleton, and 5) growth and development of the craniofacial skeleton are associated with more favorable ET/paratubal muscle vector relationships which are then reflected in better ETF test results. In a subset of these children (10/group) selected for their ability to complete MRI testing without sedataion, MRI of the ET-ME system will be obtained at age 4 and 6 years. Data will be used to reconstruct the functional mechanics of the system for comparison among groups and also with the respective mechanics generated by the craniofacial measures. This Project represents the translation of past observational studies into a longitudinal clinical study that will, for the first time, test falsifiable hypotheses suggested by those earlier results. Study results may lead to the development and application of methods for the early identification of children "at risk" for OM, for the prognosis of disease course in young children and for alternative, patient-specific interventions to prevent/cure OM.