分泌性中耳炎儿童的诊断和治疗.pptVIP

儿童分泌性中耳炎的诊治 江苏省人民医院 南京医科大学第一附属医院 分泌性中耳炎（OME）是以鼓室积液与传导性听力下降为主要特征的中耳非化脓性炎症 Catarrhal inflammation of middle ear cleft that characterized by middle ear effusion and conductive hearing loss. 无急性炎症表现（耳痛、发热、鼓膜充血肿胀）的中耳积液，但可源于急性中耳炎 OME is defined as MEE without signs and symptoms of acute inflammation (otalgia, irritability, and fever; bulging of the tympanic membrane) 概 述 儿童、婴幼儿听力下降的主要原因之一 One of the most important factor that affecting the Children’s hearing 儿童OME确切的发病率不详，因本病通常无明显临床症状。然而，几乎所有3岁左右的儿童都曾经历过至少1次中耳积液的发作 It may be difficult to determine the “true” incidence of OME because, by definition, OME is asymptomatic. However, nearly all children had experienced at least one episode by the age of 3 years Various factors interact in the pathogenesis of otitis media 病因、病理机制 — 多因素相互作用 感染 解剖、生理因素 宿主因素 环境因素 咽鼓管 (ET)-中耳 (ME)-乳突 (mast) 通气系统在OME发病中的作用. The three physiologic functions of the eustachian tube are (1) pressure regulation (ventilation), (2) protection, and (3) clearance (drainage). Of these, pressure regulation is the most important A, Pressure regulation function is related to active dilation of the tube by contraction of the tensor veli palatini muscle (TVP). 以往认为，咽鼓管功能不良是OME发生的始发及主要因素 儿童、婴幼儿咽鼓管较成人短、宽、平，更易患OME，7岁以后渐接近成人，OME发生率明显下降 中耳积液的细菌学研究 Comparison of distribution of isolates in 2807 effusions from patients with acute otitis media (AOM) and 4589 effusions from patients with otitis media with effusion (OME) at the Pittsburgh Otitis Media Research Center, 1980 to 1989. Total percentages are greater than 100% because of multiple organisms 现有研究认为: OME可能起源于慢性感染 Secretory changes in the middle ear in COME are most likely due to chronic infection 多数患者以急性感染起病 The majority of cases begin as acute infection of the middle ear 咽鼓管及中耳粘膜的炎症后反应导致持续性鼓室积液 Postinflammatory alteration in the middle ear mucosa and eustachian tube (e.g., goblet cell metaplasia and hypersecretion) lead to persistence of effusion 咽鼓管功能不良是疾病发