ET Growth and Development: Anatomy/Function

咽鼓管的生长和发育：解剖/功能 现有文献记载了咽鼓管（ET）在发病机制和/或 中耳炎（OM）的持续性。横断面研究报告称，年龄较大的儿童中OM的患病率较低， 年龄较大的儿童ET压力调节功能较好，ET形态、长度和宽度存在年龄相关差异， 和管旁肌肉组织的向量方向。这些与生长相关的ET结构变化 关系明显预示着ET功能越来越有效（F），因为ET和 管旁肌肉组织与颅底密切相关，ET系统的向量方向可以是 根据骨骼学或放射学数据重建。总之，这些观察结果表明，可测量的， ET-管旁肌向量关系的年龄相关变化反映在更有效的ETF中， 因此，OM风险降低。拟议的纵向研究的总体目标是评估 这个假设的有效性。我们计划共招募90名2至3岁的儿童（第1- 30组， 复发性急性OM，第11-30组有渗出性OM病史，第111-30组为对照组），并评估 ETF（每年一次）并测量颅面形态（通过每年一次的人体测量、每两年一次的头影测量、MRI） 4岁和6岁的亚组）。颅面测量将用于重建向量 每个孩子的ET系统的关系，并将沿着ETF结果提交给核心C， 分析了颅面形态对ETF施加限制的潜在平移机制。 这些数据将被用来检验以下假设：1）颅面的某些头影测量 形态学预测OM风险增加; 2）与这些措施的对应关系由非侵入性 人体测量; 3）ETF变量区分OM的不同临床表现; 4） ET的机械性能受到颅面骨骼的基本形式/结构的限制，并且 5)颅面骨骼的生长和发育与更有利的ET/管旁肌相关 矢量关系，然后反映在更好的ETF测试结果。在这些儿童的一个子集中（10/组） 选择能够在不使用sedataion的情况下完成MRI测试的ET-ME系统，将在 4岁和6岁。数据将被用来重建系统的功能力学进行比较 组之间，也与各自的机制所产生的颅面措施。这个项目 代表了将过去的观察性研究转化为纵向临床研究，这将是第一次， 测试早期结果提出的可证伪假设。研究结果可能会导致发展和 应用各种方法，早期识别OM“高危”儿童， 在幼儿和替代的，病人的具体干预措施，以预防/治愈OM。

EUSTACHIAN TUBE GROWTH AND DEVELOPMENT: ANATOMY/FUNCTION The existing literature documents an important role for the Eustachian tube (ET) in the pathogenesis and/or persistence of Otitis Media (OM). Cross-sectional studies report a lower prevalence of OM in older children, a better ET pressure-regulating function in older children and age-related differences in ET form, length and width, and the vector orientation of the paratubal musculature. These growth-related changes in ET structural relationships are demonstrably predictive of increasingly more efficient ET function (F) and, because the ET and paratubal musculature are intimately related to the cranial base, the vector orientation of the ET system can be reconstructed from osteological or radiographic data. Together, these observations suggest that measurable, age-related changes in ET-paratubal muscle vector relationships are reflected in more efficient ETF and, by consequence, a decreased OM risk. The overall goal of the proposed longitudinal study is to evaluate the validity of this hypothesis. We plan to enroll a total of 90 children at 2 to 3 years of age (Group 1-30with a history of recurrent actute OM, Group 11-30 with a history of OM with effusion, and Group 111-30 control) and to evaluate ETF (yearly) and measure craniofacial morphology (by yearly anthropometry, biyearly cephalometrics, MRI in a subset at age 4 and 6) over a 5 year period. The craniofacial measures will be used to reconstruct vector relationships of the ET system for each child and will be submitted along with the ETF results to Core C for analysis of the translational mechanism underlying the limitations imposed on ETF by craniofacial morphology. These data will be used to test the following hypotheses: 1) certain cephalometric measures of craniofacial morphology predict increased OM risk; 2) correspondences to these measures are represented by non-invasive anthropometric measures; 3) ETF variables discriminate between the different clinical presentations of OM; 4) the mechanical properties of the ET are limited by the underlying form/structure of the craniofacial skeleton, and 5) growth and development of the craniofacial skeleton are associated with more favorable ET/paratubal muscle vector relationships which are then reflected in better ETF test results. In a subset of these children (10/group) selected for their ability to complete MRI testing without sedataion, MRI of the ET-ME system will be obtained at age 4 and 6 years. Data will be used to reconstruct the functional mechanics of the system for comparison among groups and also with the respective mechanics generated by the craniofacial measures. This Project represents the translation of past observational studies into a longitudinal clinical study that will, for the first time, test falsifiable hypotheses suggested by those earlier results. Study results may lead to the development and application of methods for the early identification of children "at risk" for OM, for the prognosis of disease course in young children and for alternative, patient-specific interventions to prevent/cure OM.