Cantekin E I, Phillips D C, Doyle W J, Bluestone C D, Kimes K K
Ann Otol Rhinol Laryngol Suppl. 1980 May-Jun;89(3 Pt 2):47-53. doi: 10.1177/00034894800890s313.
Previous studies in humans have indicated that functional obstruction of the eustachian tube (ET) is an important factor in the pathogenesis of otitis media with effusion (OME). This type of obstruction appears to be related to the structural properties of the tube, or to an inefficient active tubal opening mechanism, or both. In this study, functional ET obstruction was created in 22 rhesus monkeys (Macaca mulatta) by surgically altering the tensor veli palatini (TVP) muscle using three different procedures: 1) complete excision of the muscle; 2) transection of the superficial muscle bundle; or 3) transposition of the muscle tendon medial to the hamular process. Prior to surgery, weekly tympanometry, pneumatic otoscopy, and otomicroscpic examinations were performed for a period of at least six months to document middle ear (ME) status. A minimum of four ET function tests were performed on each animal using the inflation-deflation and forced-response tests. Following surgery, these tests and examinations were continued for periods of up to one year. Postoperatively, the animals in which the TVP had been excised developed a sterile ME effusion which proved to be a chronic condition which persisted throughout the follow-up period. Eustachian tube function tests showed a complete absence of any active tubal dilation by swallowing. Animals that had the muscle transected developed abnormal ME pressures , or effusions, or both, which returned to normal in some ears, but which were recurrent or chronic in others. Eustachian tube function tests in these animals showed an initial loss of active tubal function which gradually improved, but not to normal levels, presumably as a result of healing of the muscle. In cases in which the muscle was transposed the ME pathology and ET dysfunction were similar after the surgery, but improved within a short period of time. These data suggest that alteration of the TVP muscle can create functional obstruction of the ET. The severity of ET obstruction depends upon the surgical procedure undertaken. The results of postoperative ET function tests were similar to those recorded from children with recurrent and chronic OME.
先前针对人类的研究表明，咽鼓管（ET）功能障碍是分泌性中耳炎（OME）发病机制中的一个重要因素。这种类型的阻塞似乎与咽鼓管的结构特性有关，或者与咽鼓管主动开放机制效率低下有关，或者两者皆有关。在本研究中，通过三种不同的手术方式改变腭帆张肌（TVP）来在22只恒河猴（猕猴）中造成功能性ET阻塞：1）完全切除该肌肉；2）切断浅表肌束；或3）将肌腱移位至翼钩内侧。手术前，每周进行鼓室导抗图检查、气导耳镜检查和耳显微镜检查，持续至少六个月以记录中耳（ME）状态。对每只动物使用充放气和强制反应测试进行至少四次ET功能测试。手术后，这些测试和检查持续进行长达一年。术后，切除TVP的动物出现无菌性ME积液，这被证明是一种慢性病，在整个随访期持续存在。咽鼓管功能测试显示吞咽时完全没有任何主动的咽鼓管扩张。切断肌肉的动物出现异常的ME压力或积液，或两者皆有，一些耳朵恢复正常，但其他耳朵则复发或呈慢性。这些动物的咽鼓管功能测试显示最初主动咽鼓管功能丧失，随后逐渐改善，但未恢复到正常水平，推测是肌肉愈合的结果。在肌肉移位的情况下，术后ME病理和ET功能障碍相似，但在短时间内有所改善。这些数据表明，TVP肌肉的改变可导致ET功能性阻塞。ET阻塞的严重程度取决于所采用的手术方式。术后ET功能测试结果与复发性和慢性OME儿童记录的结果相似。
