MEPD after TT insertion

鼓膜造口置管后中膜压失调 也许最好的临床证据支持我们的模型中耳炎与effective（OME） 中耳（ME）压力失调的发病机制是鼓膜造口管的记录积极作用 (TT)预防和解决OME事件。因为TT绕过耳咽管（ET）， 维持环境ME压力，这些观察结果表明，适当的ME压力调节，而不是其他 提示ET的功能是疾病消退的先决条件。纵向研究表明，TT后， 在具有OME的ME中插入，ME空域的体积逐渐增加，这与 减少ME炎症和积液量。我们的数学模型表明，这些变化应该 反映为通过ME粘膜的气体交换速率降低，这被认为是需求降低 放置在ET上进行气体补给。在拟议的研究中，我们将招募3岁及以上的儿童， 为OME插入TT，并在TT之间纵向测量ME气体需求、ME体积和ETF 插入和挤出，然后随访入组患者TT挤出后的疾病复发情况。这些 结果将被用于检验以下假设：1）气体通过ME粘膜（MEM）的转移减少， ME炎症和积液消退的阶段; 2）通过MEM的气体转移增加了 耳痉挛发作; 3）ETF不受TT插入的影响，以及4）ETF和transMEM气体的测量 转移（供应/需求平衡）预测TT挤出后的疾病复发和表现。结果 这些研究将用于支持或反驳我们的ME压力调节模型的测试组件， 制定TT后个别耳朵疾病复发风险分配的测试方案 挤出

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.