PROJECT 9: DIFFERENTIAL DIAGNOSIS OF OTITIS MEDIA

项目总结/摘要 项目9：中耳炎的鉴别诊断 中耳炎（OM）是儿童传导性听力损失（CHL）的最常见原因， 儿科门诊就诊、处方抗生素使用和儿科手术的原因。虽然许多临床 研究表明，OM可导致长期的感知听觉缺陷，许多其他 研究表明，OM的长期影响很小。相反，OM在动物模型中的基础研究 在他们的结果中显示出更少的模糊性，强烈表明OM和长期存在的 听觉处理缺陷临床研究文献中不明确结果的潜在原因是 OM的异质性。OM是一个总括术语，通常用于广泛定义所有类型的中耳功能障碍， 由于感染和/或中耳积液引起的耳鸣。OM可能包括或可能不包括炎性感染性疾病 OM中存在的渗出液可能是浆液性、粘液性或化脓性的，并且在两种不同的维斯中差异很大。 密度和体积。OM通常伴有CHL，但这种CHL的程度可以在0-40 dB之间变化。的 决定CHL程度的OM相关因素尚不清楚。临床研究往往只关注前- OM的重要性，以及这些OM相关变量的系统文档是有限的，至少部分原因是 没有客观的方法来区分临床人群中OM的变化。长期目标是 我们的工作是了解OM的差异如何影响长期结果。改进的差分诊断- OM的诊断是必要的，以充分量化严重程度并对该组中的变异进行分类。作为第一 步骤，这个具体建议的目的是提高OM的鉴别诊断。这些实验 将系统地研究各种类型的OM的机械效应和伴随的渗出 他们，并确定如何在OM的变化影响程度的CHL和传入听觉传输在 脑干水平。这将使我们能够通过识别OM相关的 变量，以及测量它们的工具，这些变量可能有助于识别高风险OM儿童 长期赤字。目标1将确定鼓膜移动性的非侵入性客观测量， 宽带声导抗（阿威）可用于鉴别诊断两种常见类型的OM，急性 中耳炎（AOM）与渗出性中耳炎（OME）的区别，以及检测渗出液特征的差异- 抽搐，包括渗出量、粘度和脓性。目标2将研究OM渗出液的差异 这些特征影响传入听觉信号的质量和传导性听力损失的程度。的 拟议研究的结果将导致更有效和循证治疗方案，并减少 抗生素处方的可能性，如果它不是指示。此外，这些研究将提供关键的 目前还没有关于OM的特定发作如何降低奥迪车质量的诊断信息， 将指导提供者是否有必要对OM病例进行积极管理。

PROJECT SUMMARY/ABSTRACT PROJECT 9: DIFFERENTIAL DIAGNOSIS OF OTITIS MEDIA Otitis media (OM) is the most common cause of conductive hearing loss (CHL) in children and the leading cause of pediatric office visits, prescription antibiotic use, and pediatric surgery. While a number of clinical research studies demonstrate that OM can lead to long-lasting perceptual auditory deficits, numerous other studies suggest that the long-term impact of OM is minimal. In contrast, basic studies of OM in animal models show far less ambiguity in their outcomes, strongly suggesting a direct link between OM and longstanding auditory processing deficits. A potential cause of the equivocal findings in the clinical research literature is the heterogeneity of OM. OM is an umbrella term generally used to broadly define all types of middle-ear dysfunc- tion due to infection and/or middle-ear effusion. OM may or may not include an inflammatory infectious disease process, and effusions present in OM may be serous, mucoid, or purulent, and vary considerably in both vis- cosity and volume. OM is often accompanied by CHL, but the degree of this CHL can vary from 0-40 dB. The OM-related factors determining degree of CHL are not known. Clinical studies often focus simply on the pres- ence of OM, and systematic documentation of these OM-related variables is limited, at least in part because there is no objective method to differentiate variations in OM in clinical populations. The long-term goal of this work is to understand how differences in OM affect long-term outcomes. Improvements in the differential diag- nosis of OM are necessary to adequately quantify severity and classify the variation in this group. As a first step, the purpose of this specific proposal is to improve the differential diagnosis of OM. These experiments will systematically investigate the mechanical effects of various types of OM and the effusions that accompany them, and determine how variations in OM influence degree of CHL and afferent auditory transmission at the level of the brainstem. This will allow us to subdivide this heterogeneous population by identifying OM-related variables, and tools to measure them, that may be useful in identifying children with OM who are at higher-risk for long-term deficits. Aim 1 will determine if a non-invasive objective measure of tympanic membrane mobility, wideband acoustic immittance (WAI), can be used to differentially diagnose two common types of OM, Acute Otitis Media (AOM) from Otitis Media with Effusion (OME) as well as detect differences in effusion characteris- tics including effusion volume, viscosity, and purulence. Aim 2 will investigate how differences in OM effusion characteristics influence the quality of the afferent auditory signal and degree of conductive hearing loss. The results of the proposed study will lead to more effective and evidence-based treatment protocols and reduce the likelihood of antibiotic prescription where it is not indicated. In addition, these studies will provide crucial diagnostic information not currently available as to how a specific episode of OM degrades the quality of audi- tory input and will guide providers on whether aggressive management of a case of OM may be warranted.