Csakanyi Zsuzsanna, Katona Gabor, Konya Denes, Mohos Ferenc, Sziklai Istvan
*Department of Pediatric Otorhinolaryngology, Heim Pal Children's Hospital, 13 Delej utca, H-1089 Budapest, Hungary; †Budapest University of Technology and Economics, 3-9 Műegyetem rkp, H-1111 Budapest, Hungary; ‡Faculty of Engineering, University of Szeged, 13 Dugonics square, H-6720 Szeged, Hungary; and §Department of Otorhinolaryngology and Head and Neck Surgery, Health Science Centre, University of Debrecen, 98 Nagyerdei krt., H-4032 Debrecen, Hungary.
Otol Neurotol. 2014 Jul;35(6):944-53. doi: 10.1097/MAO.0000000000000282.
To establish a mathematical model of middle ear gas pressure regulation and to discuss potential implications for pathophysiology-oriented theoretical approach to middle ear surgery, with particular attention to mastoid obliteration.
Numerous studies support that small mastoid volume is associated with cholesteatoma. Latest studies show that mastoid obliteration is an effective technique to lower the recurrence rate in these ears.
A mathematical model was used to predict the development of gas pressure balance in the function of different middle ear volumes (VME), considering normal and dysfunctional Eustachian tube. Published data as gas pressure input values and our 3D CT reconstruction data in healthy and pathologic middle ears of children were applied.
The model predicted ≤6.66 daPa pressure fluctuations in VME ≥3 ml, compared to ≥16 daPa of a VME ≤1 ml at perfect ET function, because of the different pressure change rate and pressure buffer effect of the MEs. Substantially larger fluctuations can be expected in a VME <3 ml with malfunctioning ET. Modeling mastoid obliteration predicts similar pressure fluctuations to a VME ≥3 ml resulting from elimination of gas exchange surface.
Pressure change is faster in smaller MEs than in larger ones. Healthy MEs between 3 and 6 ml are very sensitive to the duration of a potential ET dysfunction to develop ME pathology. In MEs with poor mastoid pneumatization and dysfunctional ET, typical in cholesteatoma cases, mastoid obliteration as surgical reduction of mucosal surface for gas exchange can improve ME gas pressure balance resulting in better long-term outcome.
建立中耳气压调节的数学模型，并探讨其对以病理生理学为导向的中耳手术理论方法的潜在影响，尤其关注乳突填充术。
大量研究支持小乳突体积与胆脂瘤相关。最新研究表明，乳突填充术是降低这些耳朵复发率的有效技术。
使用数学模型来预测在不同中耳体积（VME）功能下气压平衡的发展情况，同时考虑正常和功能障碍的咽鼓管。应用已发表的数据作为气压输入值以及我们在儿童健康和病理中耳中的三维CT重建数据。
该模型预测，在咽鼓管功能正常时，VME≥3 ml时压力波动≤6.66 daPa，而VME≤1 ml时压力波动≥16 daPa，这是由于中耳不同的压力变化率和压力缓冲效应。在咽鼓管功能异常的情况下，VME<3 ml时预计压力波动会大得多。对乳突填充术进行建模预测，由于气体交换表面的消除，其压力波动与VME≥3 ml时相似。
较小的中耳压力变化比大的中耳更快。3至6 ml的健康中耳对潜在咽鼓管功能障碍发展为中耳病理的持续时间非常敏感。在胆脂瘤病例中典型的乳突气化不良和咽鼓管功能障碍的中耳中，作为减少气体交换黏膜表面的手术方法的乳突填充术可以改善中耳气压平衡，从而带来更好的长期效果。
