Studies of proliferating and ingibiting factors to the transformation from infant secretory otitis media to cholesteatoma

获得性胆脂瘤起源于婴幼儿慢性分泌性中耳炎后遗症，分为软化型和扁平型。这些研究的目的是阐明促进或阻止胆脂瘤发展的因素。接下来进行的研究是为了实现这一目标。术中详细观察胆脂瘤基质的进展，对SOM患者进行长期随访，炎性颞骨尤其是硬化性乳突的形态学研究，中耳和乳突粘膜分泌腺的盛衰，胆脂瘤的表皮细胞和基质的培养研究，SOM的表皮细胞和鼓膜超微结构的研究。这些研究结果解释了分泌性中耳炎(SOM)向胆脂瘤进展的促进剂。输卵管功能不全，乳突气细胞系统受抑，乳突充气受阻。此外，轻度炎症、负压、生长因子对鼓膜上皮的持续作用是胆脂瘤发生的促进因素。胆脂瘤发生的重要机制是纤维消失和鼓膜粘连，而阻止胆脂瘤发展的必要条件是早期输卵管功能的改善，尤其是儿童时期的改善，受抑制的乳突再气化，鼓室穿孔的发生和粘连的预防。从这些结果来看，慢性分泌性中耳炎置管是一种理想的治疗方法。

The acquired cholesteatoma originats from sequela of chronic infant secretory otitis media(SOM) and is diveded into two categories, that is flaccida type and tenza type. The purpose of the studies are that elucidate the factors which promote or prevent the development of cholesteatomaNext studies were performed to accomplish this aim. Detailed observation for the advance of cholesteatoma matrix during surgeries, long term following up to the patients with SOM, morphological study of inflammatory temporal bone especially of sclerotic mastoid.Prosperity and decay of secretory glands of mucose membrane of the middle ear and mastoid, culture study of epedermal cells and matrix of cholesteatoma, besides study of prowth factors to the epidermal cell, ultrastructure of the ear drum of SOM.As the results of these studies, the promoters of progression from secretory otitis media(SOM) to cholesteatoma can be explained as follows. Deficiency of tubal function, suppressed air cell system of mastoid and blockage of aeration to the mastoid. Besides, continuance of slight inflammation, negative pressure, growth factors to the epidermis of tympanic membrane in the attic are promoting factors to cholesteatoma. Further, disappearance of fibers in pars tneza and adhesion of tympanic membrane are important mechanism to promote the developmnet of tenza cholesteatoma.On the other hand, the essential conditions for arresting the development to cholesteatoma are as follows, early improvement of tubal function especially at the age of childhood, re-pneumatization of suppressed mastoid, occurrence of tympanic perforation and prevention of adhesion. From these consequences insertion of ventilation tube to the chronic secretory otitis media is ideal procedure.