Pathogenesis and Managements for Chronic Secretory Otitis Media.

1)我们的流行病学研究显示，有急性中耳炎、鼻窦炎和腺样体肥大病史的儿童，分泌性中耳炎的相对危险性明显较高。这些结果表明中耳和上呼吸道的急性和慢性炎症是SOM发病的原因。2）研究了中耳积液中花生四烯酸的代谢，以阐明介导SOM炎症反应的因素。中耳积液中前列腺素（PG）E_2、<2alpha>F_2和6-酮-PGF_3的含量<2alpha>均高于成人。积液中的炎性细胞在儿童中也更多。这些结果表明，炎症反应更加速在儿童的SOM。3）超微结构检查的中耳粘膜从两个不同年龄组（儿童和成人）显示没有显着差异，在中耳粘膜的衬里。4）90耳中耳积液的治疗插入通气管（VT）插入。VT插入后，通过鼓室导抗法测量中耳空气容量（MEAV）。发现MEAV小于1.5ml的耳中，中耳积液的复发率非常高。5）我们试图评估Kampo药物治疗SOM的疗效。心房药选用的是含有12种不同植物的基本干提取物的西令藤（TJ-114），通过实验室动物实验证明具有抗炎和抗过敏作用。目前的初步开放试验研究显示，TJ-114在8.7%的耳外完全消退，在19.6%的耳外显著改善。21.7%的患者没有改善。

1) Our epidemiologic studies revealed that the relative risk for secretory otitis media was significantly high in children who had the histories of acute otitis media, sinus troubles and adenoids vegetation. This results suggest that acute and chronic inflammation of the middle ear as well as the upperrespiratory tract is responsible in the onset of SOM.2) Arachidonate metabolism in the middle ear effusion was studied to clarify factors mediating inflammatory responses in SOM. The concentrations of prostaglandin (PG) E_2, F_<2alpha>, and 6-keto-PGF_<2alpha> were higher in the middle ear effusions of children than in those of adults. The inflammatory cells in the effusion were also more numerous in the children. These results suggest that inflammatory reactions are more accelerated in the children's SOM.3) Ultrastructural Examinations of the middle ear mucosa from two different age groups (children and adults) revealed no significant differences in the lining mucosa of the middle ear.4) Ninety ears with middle ear effusions were treated by insertion of a ventillation tube (VT) insertion. Following VT insertion, the middle ear air volume (MEAV) was measured by tympanometry. It was found that very high recurrence rate of the middle ear effusions was seen in the ears with small MEAV less than 1.5 ml.5) We attempted to assess the efficacy of Kampo-medicine in SOM. Sairei-to (TJ-114) was chosen as atrial medicine which contains 12 basic dry extracts from various plants and vegetalbes and which has been proven to have anti-inflammatory and anti-allergic effects through animal experiments in the laboratory. The present preliminary open trial study revealed that TJ-114 brought complete resolution in 8.7% out of ears and significant improvement in 19.6%. No improvement was found in 21.7%.