Mitani Y
Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo.
Nihon Jibiinkoka Gakkai Kaiho. 1998 Aug;101(8):1000-11. doi: 10.3950/jibiinkoka.101.8_1000.
Most otitis media with effusion (OME) in children heals spontaneously, but it is sometimes persistent and intractable. The major factors determining these different courses of OME are unknown. Identifying such factors would be clinically helpful. Factors affecting on the outcome of OME were studied experimentally and clinically. In animal experiment OME was induced in rabbit by occluding the Eustachian tube. Clinical study was conducted by investigating a histology of the middle ear mucosa, sampled from 64 children with OME (87 ears) who underwent middle ear tube ventilation. Furthermore, these cases studied how the degree of mastoid pneumatization before and after treatment, changes in the volume of the middle ear air cavity and the course after removal of the middle ear ventilation tube affected lesions in the middle ear mucosa. In animals, histology of the middle ear mucosa showed that in the early stages, the subepithelial layer of the middle ear mucosa was characterized by edematous hypertrophy and enlarged blood vessels. In later stages, it became fibrous as a result of chronic inflammation. These results suggest that lesions of the subepithelial layer are unlikely to recover. In clinical cases, histological changes in mucosal samples were rated on a two-point scale: changes in the epithelium and changes in the subepithelial layer. Re-pneumatization, a sign of healing of middle ear mucosal inflammation, was seen 12 months to 18 months after surgery. Among patients in whom the tube was left inserted for more than 18 months, only 11% had unfavorable outcomes and the recurrence rate was low. All patients who had recurrence of disease despite more than 18 months of tube insertion had prolonged inflammation in the middle ear mucosa. There results indicate that the air cavity returns to approximately normal degree of pneumatization more than 18 months after surgery, and that the extent of lesions in the middle ear mucosa, especially the subepithelial layer, is closely related to the healing of OME.
大多数儿童分泌性中耳炎（OME）可自愈，但有时会持续不愈且难以治疗。决定OME这些不同病程的主要因素尚不清楚。识别此类因素将有助于临床诊断。我们通过实验和临床研究了影响OME预后的因素。在动物实验中，通过阻塞咽鼓管在兔子身上诱发OME。临床研究则是对64例接受中耳置管通气的OME患儿（87耳）的中耳黏膜组织学进行调查。此外，这些病例还研究了治疗前后乳突气化程度、中耳气腔容积变化以及去除中耳通气管后的病程如何影响中耳黏膜病变。在动物中，中耳黏膜组织学显示，早期中耳黏膜上皮下层表现为水肿性肥大和血管扩张。后期，由于慢性炎症而变为纤维化。这些结果表明上皮下层病变不太可能恢复。在临床病例中，黏膜样本的组织学变化按两点量表进行评分：上皮变化和上皮下层变化。中耳黏膜炎症愈合的标志——再气化，在手术后12个月至18个月出现。在置管超过18个月的患者中，只有11%的预后不佳且复发率较低。所有尽管置管超过18个月仍疾病复发的患者，中耳黏膜均有长期炎症。这些结果表明，手术后18个月以上气腔恢复到大致正常的气化程度，中耳黏膜病变程度，尤其是上皮下层病变程度与OME的愈合密切相关。
