MEPD after TT insertion

TT 插入后的 MEPD

• 批准号: 7657385
• 负责人: ELLEN M MANDEL
• 金额: $ 17.33万
• 依托单位: CHILDREN'S HOSP PITTSBURGH/UPMC HLTH SYS
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7657385
• 关键词: 3 year old; Bolus Infusion; Bypass; Child; Clinical; Clinical Research; Condition; Constitutional; Data; Disease; Ear; Economic Inflation; Edema; Enrollment; Equilibrium; Eustachian Tube; Feedback; Frequencies; Functional disorder; Gases; Healed; Human; Individual; Inflammation; Longitudinal Studies; Measurement; Measures; Medical; Methods; Modeling; Mucous Membrane; Noble Gases; Otitis Media; Otitis Media with Effusion; Otorrhea; Pathogenesis; Patient observation; Patients; Phase; Protocols documentation; Rate; Recurrence; Regulation; Research Personnel; Resolution; Risk; Solid; Testing; Time; Tube; Tympanostomy; Tympanostomy Tube Insertions; aged; concept; disorder prevention; effusion; expectation; healing; mathematical model; middle ear; pressure; prevent; programs; theories

MIDDLE EAR PRESSURE DEREGULATION AFTER TYMPANOSTOMY TUBE INSERTION Perhaps the most well supported clinical evidence for our model of Otitis Media with Effusion (OME) pathogenesis by middle ear (ME) pressure disregulation is the documented positive effect of tympanostomy tube (TT) insertion in preventing and resolving OME episodes. Because TTs bypass the Eustachian tube (ET) to maintain ambient ME pressure, these observations suggest that adequate ME pressure-regulation and not other suggested functions of the ET is prerequisite for disease resolution. Longitudinal studies show that after TT insertion in MEs with OME, the volume of the ME airspace progressively increases which correlates with decreasing ME inflammation and effusion volume. Our mathematical model shows that these changes should be reflected as lesser rates of gas exchange across the ME mucosa which are realized as a decreased demand placed upon the ET for gas resupply. In the proposed study, we will enroll children aged 3 years and older with TTs inserted for OME and measure the ME gas demand, ME volume and ETF longitudinally between TT insertion and extrusion, and then follow the enrolled patients for disease recurrence after TT extrusion. These results will be used to test the hypotheses that: 1) gas transfer across the ME mucosa (MEM) decreases in phase with resolution of ME inflammation and effusion; 2) gas transfer across the MEM is increased by an episode of otorrhea; 3) ETF is unaffected by TT insertion, and 4) measurement of ETF and transMEM gas transfer (supply/demand balance) predicts disease recurrence and presentation after TT extrusion. The results of these studies will be used to support or refute tested components of our model of ME pressure-regulation and to develop test protocols for risk assignments with respect to disease recurrence in individual ears after TT extrusion.

鼓膜置管术后中耳压力松弛 可能是我们的渗出性中耳炎模型(OME)最可靠的临床证据 鼓室造瘘管的积极作用是中耳压力失调的发病机制 (TT)在预防和解决OME发作中插入。因为TTS绕过咽鼓管(ET) 维持环境ME压力，这些观察表明适当的ME压力调节，而不是其他 建议的ET功能是疾病解决的先决条件。纵向研究表明，在TT之后 在MES中插入OME时，ME空域的体积逐渐增加，这与 减少ME炎症和渗出量。我们的数学模型表明，这些变化应该 反映为跨ME粘膜的气体交换速率较低，实现为需求减少 放置在ET上以进行气体再补给。在拟议的研究中，我们将招收3岁及以上的儿童 为OME插入TTS，并在TT之间纵向测量ME气体需求量、ME体积和ETF 插入和挤出，然后跟踪纳入的患者在TT挤出后的疾病复发。这些 结果将被用来检验假设：1)跨ME粘膜的气体转移(MEM)在 ME炎症和渗出的消退阶段；2)跨MEM的气体转移增加了 耳漏；3)ETF不受TT插入的影响；4)ETF和TransMEM气体的测量 转移(供需平衡)预测疾病复发和TT排出后的表现。结果是 将被用来支持或驳斥我们的ME压力调节模型的测试组件和 制定关于TT后个体耳部疾病复发风险分配的测试方案 拉伸。