Clinical Application of a Microbiological Study on Chronic Suppurative Otitis Media

Our prospective study conducted over a period of 9 months includes 100 samples of ear discharge collected from 90 patients suffering from tubo-tympanic type of chronic suppurative otitis media (CSOM). The ear discharge which is collected with sterile swabs is subjected to Gram’s staining and culture of the causative organism. Antibiotic sensitivity test of cultured bacterial growth is undertaken to know the susceptibility of the causative organism. Of the 100 samples, 62 were culture positive where Pseudomonas aeruginosa was the most common pathogen followed by Staphylococcus aureus. Most of the cultured organisms in our study were sensitive to drug Ciprofloxacin. The outcome of our study enabled us to set an empirical medical treatment for an early resolution of ear discharge and inflammation in our patients with CSOM as we could understand the aetiological pathogens and their susceptibility pattern. Effective medical treatment in obtaining a discharge free ear prior to surgical treatment led us to improve the surgical outcome in our patients with CSOM.

Chronic otitis media and middle ear variants:Is there relation?

BACKGROUND Chronic otitis media(COM)is an inflammatory disease that lasts for a long time.It is common in developing countries.Hearing loss can result from COM.The relationship between variations in middle ear anatomy and COM was investigated in our study.AIM To compare the prevalence of middle ear anatomic variations between the cases with COM and healthy individuals.METHODS This retrospective study included 500 patients with COM and 500 healthy controls.The presence of those variants was determined:Koerner’s septum,facial canal dehiscence,high jugular bulb,jugular bulb dehiscence,jugular bulb diverticulum,sigmoid sinus anterior location and deep tympanic recesses.RESULTS A total of 1000 temporal bones were examined.The incidences of these variants were respectively(15.4%-18.6%),(38.6%-41.2%),(18.2%-4.6%),(2.6%-1.2%),(1.2%-0%),(8.6%-0%),(0%-0%).It was observed that only high jugular bulb(P<0.001)and anteriorly located sigmoid sinus frequencies(P=0.002)in the case group were statistically significantly higher than the control groups.CONCLUSION COM is a multifactorial disease and variants of middle ear have always been important in terms of potential risk for complication during surgery but rarely associated with COM as an etiology or as a consequence of the disease.We didn't find a positive correlation between COM and Koerner’s septum and facial canal defect.We ended up with a significant conclusion with the variants of dural venous sinuses-high jugular bulb,dehiscence of jugular bulb,diverticulum of jugular bulb and anteriorly located sigmoid sinus-that have been studied less and frequently associated with inner ear illnesses.

Aerobic bacteria associated with chronic suppurative otitis media in Angola

Background:Chronic suppurative otitis media(CSOM)is an important cause of hearing loss in children and constitutes a serious health problem globally with a strong association to resource-limited living conditions.Topical antibiotics combined with aural toilet is the first-hand treatment for CSOM but antimicrobial resistance and limited availability to antibiotics are obstacles in some areas.The goal of this study was to define aerobic pathogens associated with CSOM in Angola with the overall aim to provide a background for local treatment recommendations.Methods:Samples from ear discharge and the nasopharynx were collected and cultured from 152 patients with ear discharge and perforation of the tympanic membrane.Identification of bacterial species was performed with matrix-assisted laser desorption/ionization-time of flight mass spectrometry and pneumococci were serotyped using multiplex polymerase chain reactions.Antimicrobial susceptibility testing was done according to EUCAST.Results:One hundred eighty-four samples from ear discharge and 151 nasopharyngeal swabs were collected and yielded 534 and 289 individual isolates,respectively.In all patients,correspondence rate of isolates from 2 ears in patients with bilateral disease was 27.3%and 9.3%comparing isolates from the nasopharynx and ear discharge,respectively.Proteus spp.(14.7%),Pseudomonas aeruginosa(13.2%)and Enterococcus spp.(8.8%)were dominating pathogens isolated from ear discharge.A large part of the remaining species belonged to Enterobacteriaceae(23.5%).Pneumococci and Staphylococcus aureus were detected in approximately 10%of nasopharyngeal samples.Resistance rates to quinolones exceeded 10%among Enterobacteriaceae and was 30.8%in S.aureus,whereas 6.3%of P.aeruginosa were resistant.Conclusions:The infection of the middle ear in CSOM is highly polymicrobial,and isolates found in nasopharynx do not correspond well with those found in ear discharge.Pathogens associated with CSOM in Angola are dominated by gram-negatives including Enterobacteriaceae and P.aeruginosa,while gram-positive enterococci also are common.Based on the results of antimicrobial susceptibility testing topical quinolones would be the preferred antibiotic therapy of CSOM in Angola.Topical antiseptics such as aluminium acetate,acetic acid or boric acid,however,may be more feasible options due to a possibly emerging antimicrobial resistance.

A comparative study of sequential vs.simultaneous type Ⅰ tympanoplasty in patients with bilateral chronic otitis media-Mucosal type

Background:Patients with bilateral chronic otitis media-mucosal type have been conventionally treated with sequential tympanoplasty.Bilateral simultaneous tympanoplasty is usually not preferred because of the theoretical risk of iatrogenic sensorineural hearing loss.With the advent of modern surgical instruments and surgical techniques,the risk is expected to be lower.This study compares the clinical outcomes in typeⅠtympanoplasty performed simultaneously and sequentially.Materials&methods:This randomized prospective study was carried out in a tertiary care hospital between August 2015 and July 2017.A total of 30 patients were divided into two groups of 15 each.This study analyzed the graft uptake,pure tone audiogram findings pre-and post-operatively,duration of surgery and number of hospital visit for each patient and the outco mes were co mpared between both the groups.Result:Patients undergoing bilateral simultaneous tympanoplasty had significantly lesser mean duration of surgery and number of hospital visits than the patients undergoing sequential tympanoplasty.Graft uptake and postoperative wound infections were similar in both the groups.Postoperative hearing improvement was significantly better in the bilateral simultaneous tympanoplasty group.However,further studies are needed to authenticate this observation.None of the patients had a postoperative deterioration of hearing or sensorineural hearing loss.Conclusion:Bilateral simultaneous tympanoplasty is not only feasible but also better than sequential tympanoplasty,especially in terms of operating time,follow-up and overall financial implications on the patient.

Chronic otitis media and subsequent hearing loss in children from the Himalayan region residing in Buddhist Monastic schools of Nepal

Objectives:The main objective of the study was to ascertain the prevalence of chronic otitis media and determine the corresponding hearing loss in children from Nepal’s Himalayan region now residing in Buddhist Monastic schools of Nepal.Methods:The study was conducted among children at Buddhist monastic school in different parts of Nepal.A total of 3174 children aged between 5 and 15 years,who were originally from the Himalayan region of Nepal and were currently residing in monastic schools,were screened for ear problems and hearing loss.They were examined by otoscope to diagnose chronic otitis media.Hearing was evaluated by pure tone audiometer,and 0.5e4 kHz air conduction hearing threshold was measured and documented.Results:Of the total of 3174 children who were screened for ear diseases and hearing loss,monks constituted 76.21%(n?2419)and Nuns 23.78%(n?755).Chronic otitis media was the most common otoscopic finding during the screening,and it affected a total of 344(10.83%)children.Out of these 344,hearing loss of varying degrees was observed in 5.42%(n?172)children.Conclusion:There is high prevalence of chronic otitis media in children belonging to the Himalayan region of Nepal,and it is the main cause of avoidable hearing loss.Timely diagnosis and treatment of chronic otitis media could prevent unnecessary hearing loss in these children.

Aural Toileting and Dressing—Important Intervention Measures in the Management of Acute Suppurative Otitis Media

Background: Otitis media is one of the most common childhood infections, the leading cause of doctor’s visit by children in ENT clinic. The acute form if not recognized early is commonly characterized by suppuration from the middle ear following perforation of the tympanic membrane otherwise referred to as acute suppurative otitis media (ASOM). If not adequately treated, it progresses to chronic suppurative otitis media with attendant challenges in management. Ceasation of ear discharge is an indication of resolution of disease. The objective of this study is to appraise the value of local ear suction toileting and dressing in the ceasation of ear discharge in acute suppurative otitis media. Materials and Method: Consecutive new cases of acute suppurative otitis media seen at the Ear, Nose and Throat clinic of a tertiary health centre in north western Nigeria were assessed for efficacy of aural toileting and dressing with antibioctic impregnated guaze in the treatment of acute suppurative otitis media and compared with patients with similar disease without aural toileting and dressing or dressing with normal saline soaked guaze in addition to systemic antibiotic and antihistamine medications. Ear toileting was done by suctioning the discharge with suction machine, and cleaning the external auditory canal with hydrogen peroxide and methylated spirit. They were then dressed with gauze impregnated with antibiotic ear drops daily until there was no more ear discharge. The period of ceasation of ear discharge in each group was assessed. Results: There were 39 patients with acute suppurative otitis media (ASOM). Eighteen were females (46.2%) while 21 were males (53.8%), giving M:F ratio 1:2.1. Their ages ranged between 1 month and 45 years. About 36 (92.3%) were children and out of this, 28 (77.8%) were less than 5 years old. The average period of ceasation of discharge was 24 - 48 hours with those undergoing ear toileting and dressing but varied between 7 and 10 days with those without ear dressing or dressing with normal saline soaked guaze. This finding compelled us to stop the study on ethical grounds when this was carried out in the first 5 patients on each side of the study groups necessitating reversals of other groups to aural toileting and dressing with antibiotic impregnated guaze. Conclusion: Local ear toileting and dressing appear to show significant contribution to the early ceasation of ear discharge and are highly recommended not only for acute suppurative otitis media but also for all suppurative ear diseases.

Surveillance of antibiotic sensitivity pattern in chronic suppurative otitis media of an Indian teaching hospital

Introduction:Chronic suppurative otitis media (CSOM) is a common problem in worldwide and untreated CSOM leads to fatal complications like facial nerve paralysis,lateral sinus thrombosis,labyrinthitis,meningitis and brain abscess in developing country like India.Objective:To isolate causative bacteria and antibiotic sensitivity pattern for CSOM and to know the prevalence of extended spectrum beta lactamases (ESBL) and Metallobetalactamases (MBL) in CSOM patients.Methods:A total of 500 ear swabs of clinical suspected CSOM patients were cultured on specific cultured medium and identified the bacteria with conventional methods.Then all the identified bacteria were subjected with specific antibiotics by the Kirby-Bauer's method to know the resistance pattern of antibiotics.ESBL and MBL strains were detected by double disc diffusion test.Results:A total of 384 bacteria were isolated from 500 CSOM patients,among them 86 P.aeruginosa (22.40%),112 Staphylococcus aureus (29.17%),53 A.baumannii (13.80%),32 E.aerogenes (18%),26 C.freundii (6.77%),24 K.oxytoca (6.25%),23 P.vulgaris (5.99%),18 K.pneumoniae (4.69%) and 10 P.mirabilis (2.60%) identified with conventional methods.From antibiotic disc diffusion methods 74.22% ESBL strains and 9.90%MBL strains were documented.Multidrug resistant strains of P.aeruginosa (86/384,22.40%) were more prevalent than those of S.aureus (112/384,29.17%) and other bacteria in ear discharges.Imipenem and vancomicin could control to gram negative bacteria and gram positive bacteria respectively.Conclusion:Continuous and periodic evaluation of microbiological profile and antimicrobial sensitivity pattern of bacterial is essential for optimum management of CSOM patients.

Balloon dilation of Eustachian tube combined with tympanostomy tube insertion and middle ear pressure equalization therapy for recurrent secretory otitis media

Objective: To report outcomes of balloon dilation Eustachian tuboplasty combined with tympanostomy tube insertion and middle ear pressure equalization therapy in treatment of recurrent secretory otitis media. Methods: Fifty one patients with recurrent secretory otitis media (62 ears) underwent balloon dilation of Eustachian tube and tympanic tube insertion under general anesthesia, followed by long term middle ear pressure equalization therapies. The Eustachian tube score (ETS) and Eustachian tube function questionnaire (ETDQ-7) were used for pre- and postoperative (up to 12 months) evaluation of Eustachian tube functions. Results: The mean ETS score was 2.34 ± 0.97 preoperatively, and 6.17 ± 1.54, 7.23 ± 1.62, 8.24 ± 1.97, and 7.63 ± 1.86 at 1, 3, 6 and 12 months postoperatively, respectively (P < 0.05). The ETDQ-7 score was 4.82 ± 1.07 preoperatively, and 2.20 ± 0.54, 2.32 ± 0.68, 2.53 ± 0.79, and 2.67 ± 0.76 at 1, 3, 6 and 12 months postoperatively, respectively (P < 0.05). Conclusion: Balloon dilation of Eustachian tube combined with tympanostomy and catheterization resulted in significant improvement of subjective symptoms and objective evaluation of Eustachian tube functions in most patients with recurrent secretory otitis media, as indicated by the ETS and ETDQ-7 scores, demonstrating high levels of efficacy and patient satisfaction.

Evaluation and significance of Eustachian tube angles and pretympanic diameter in HRCT temporal bone of patients with chronic otitis media

Objective:To evaluate the significance of Eustachian tube(ET)angles and ET pretympanic diameter on high resolution computed tomography(HRCT)Temporal bone in patients with chronic otitis media(COM).Methods:A retrospective study was carried out at Tertiary care centre.Group A included 92 ears with COM(38 patients with bilateral COM and 16 with unilateral COM);and Group B included 108 normal ears(54 patients with bilateral normal ears).Reid plane-ET angle,Tubotympanic angle and the ET pretympanic diameter was evaluated by HRCT temporal bone,and compared in the two groups.Patients with chronic otitis media(Group A)were subdivided into Group A1(Blocked ET)and Group A2(Patent ET).The parameters were evaluated and compared in the subgroups too.Results:The mean Reid plane-ET angle and Tubotympanic angle in Group A was 25.41
2.57 and 148.12
3.43 respectively;whereas in Group B it was 27.56
3.62 and 145.14
4.34 respectively.Reid plane-ET angle was significantly less in patients with COM and Tubotympanic angle was significantly more obtuse in COM patients.ET pretympanic diameter was(5.37
2.10)mm in Group A and(6.47
2.40)mm in Group B.It was significantly less in patients with COM.A significant correlation was found between the ET patency and the two ET parameters(Reid plane-ET angle and pretympanic diameter).Conclusions:Eustachian tube angles in adults may play a significant role in the etiology of chronic otitis media.Decrease in Reid plane-ET angle and pretympanic diameter on HRCT temporal bone can be used to predict ET dysfunction and to plan the surgical management of chronic otitis media.

Transcription factors T-bet/GATA-3/Foxp3 in peripheral blood of patients with chronic otitis media with effusion

To the Editor:Otitis media with effusion(OME),also known as secretory otitis,is a disease in which secreted fluid accumulates in the middle ear cavity and is a major cause of hearing loss,both in children and adults.[1]Causes of OME include recurrent infections,inflammatory conditions,malformations,and eustachian tube dysfunctions.[2]Although most patients could recover spontaneously,by medication,or by surgery,some patients show frequent recurrence of otitis media for more than 3 months,called chronic otitis media with effusion(COME).[1]The pathogenesis of COME is not completely understood.Increasing evidence suggests a central role of immunologic cells and th&r associated cytokines in the chronic inflammation that characterizes COME.

慢性化脓性中耳炎患者耳鸣发生现况、高危因素及预测模型构建与评价

目的分析慢性化脓性中耳炎患者耳鸣发生现况,调查高危因素并构建预测模型。方法选取2020年10月至2022年10月南阳市中心医院耳鼻咽喉头颈外科就诊的103例慢性化脓性中耳炎患者,回顾性收集患者的临床资料,分析慢性化脓性中耳炎患者耳鸣发生现况。通过单因素及多因素分析慢性化脓性中耳炎患者耳鸣发生的高危因素,建立预测模型,并绘制受试者工作特征(ROC)曲线分析预测模型对慢性化脓性中耳炎患者耳鸣发生的预测价值。结果103例慢性化脓性中耳炎患者耳鸣发生45例(43.69%)纳入耳鸣组,非耳鸣组58例。多因素logistic分析结果显示,咽鼓管鼓口异常、睡眠障碍、血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)水平升高为慢性化脓性中耳炎患者耳鸣发生的高危因素(P<0.05)。将上述因素纳入预测模型,将耳鸣患者纳入阳性,非耳鸣患者纳入阴性,按照预测模型绘制ROC曲线,结果显示,当logit(P)>14.60时,曲线下面积(AUC)为0.906,灵敏度为86.67%、特异度为87.93%。结论慢性化脓性中耳炎患者耳鸣发生率较高,咽鼓管鼓口异常、睡眠障碍、血清IL-6、IL-8、TNF-α水平升高与疾病发生密切相关,据此建立的预测模型预测价值较高,可为临床防治策略制定提供依据。

耳聋左慈丸治疗慢性分泌性中耳炎临床疗效及作用机制研究

目的 观察耳聋左慈丸联合西医疗法治疗慢性分泌性中耳炎的临床疗效,并分析其作用机制。方法 选择2022年1月—2022年12月于医院耳鼻喉科治疗的200例慢性分泌性中耳炎患者,采用随机数字表法将上述患者分为对照组和试验组,每组100例,对照组患者予以西医常规治疗,试验组在对照组基础上予以耳聋左慈丸治疗。比较两组患者的临床疗效、症状和不良反应情况,以及治疗前后听力水平、耳积液炎症因子水平变化。结果 对照组患者的有效率为(80.00%,80/100),试验组患者的有效率为(90.00%,90/100),与对照组比较,试验组的有效率明显升高(P<0.05)。治疗前、治疗后1周两组患者的ETDQ-7无明显差异(P>0.05);治疗后3周后,试验组患者的ETDQ-7水平相较于对照组均明显下降(P<0.01)。干预完成后,试验组患者耳鸣、耳闷、听力下降以及鼓室积液等主要症状评分水平相较于对照组均明显降低(P<0.01)。干预完成后,与对照组患者比较,试验组患者0.5、1、2 kHz的纯音听阈明显降低,差异具有统计学意义(P<0.01)。干预前两组患者的耳积液炎症因子水平差异无统计学意义(P>0.05);干预完成后,试验组患者耳积液中IL-1β、IL-8以及TNF-α水平相较于对照组均明显下降(P<0.01)。干预过程中所有患者的主要不良反应有恶心呕吐、食欲不振、腹痛腹泻、头晕头痛等,两组患者的不良反应发生率差异无统计学意义(P>0.05)。结论 耳聋左慈丸联合西医疗法治疗慢性分泌性中耳炎具有良好的临床效果,提高患者听力水平,改善临床症状,抑制局部炎症反应,且无不良反应增加。

不同乳突根治术联合鼓室成形术治疗慢性化脓性中耳炎的临床效果对比

目的探讨不同乳突根治术联合鼓室成形术治疗慢性化脓性中耳炎的临床效果。方法86例慢性化脓性中耳炎患者根据手术方法的不同分为两组。完壁组采用完壁式乳突根治术联合鼓室成形术治疗,开放组采用开放式乳突改良根治术联合鼓室成形术治疗。比较两组的术后恢复情况、复发率及听力阈值。结果术后,两组的鼓膜愈合情况比较,差异无统计学意义(P>0.05);完壁组的干耳时间短于开放组,复发率高于开放组(P<0.05)。术后6个月,两组的500、1000、2000 Hz听力阈值比较,差异无统计学意义(P>0.05);完壁组的4000 Hz听力阈值低于开放组(P<0.05)。结论与开放式乳突改良根治术联合鼓室成形术相比,完壁式乳突根治术联合鼓室成形术对慢性化脓性中耳炎患者高频听力的重建效果更佳,术后干耳更快,但复发率较高。

慢性化脓性中耳炎患者行鼓室成形术中植入钛人工听骨链在降低听力阈值及改善听力状态中的价值

目的探讨鼓室成形术中植入钛人工听骨链降低慢性化脓性中耳炎患者听力阈值、改善听力状态的效果。方法选取河南科技大学第二附属医院耳鼻咽喉科2019年1月至2022年1月80例慢性化脓性中耳炎患者作为研究对象,随机数字表法分为对照组(40例)和植入组(40例)。对照组采取单纯鼓室成形术,进行自体听骨链重建,未植入钛人工听骨链,植入组患者在行鼓室成形术中植入钛人工听骨链,对比两组术前术后纯音听力重建水平,听力状态改善效果及并发症、复发率。结果植入组听力改善有效率高于对照组(P<0.05);术后听力阈值均较术前降低,且植入组气导听力阈值、气骨导差低于对照组(P<0.05),骨导听力阈值组间差异无统计学意义(P>0.05);两组术后并发症发生率、复发率差异无统计学意义(P>0.05)。结论在行鼓室成形术中植入钛人工听骨链能有效提升慢性化脓性中耳炎患者的听力水平,降低气导听力阈值及气骨导差,且不增加术后并发症及疾病复发风险,效果确切,值得临床应用及进一步研究。

Diagnosis of Middle Ear Diseases Based on Convolutional Neural Network

An otoscope is traditionally used to examine the eardrum and ear canal.A diagnosis of otitis media(OM)relies on the experience of clinicians.If an examiner lacks experience,the examination may be difficult and time-consuming.This paper presents an ear disease classification method using middle ear images based on a convolutional neural network(CNN).Especially the segmentation and classification networks are used to classify an otoscopic image into six classes:normal,acute otitis media(AOM),otitis media with effusion(OME),chronic otitis media(COM),congenital cholesteatoma(CC)and traumatic perforations(TMPs).The Mask R-CNN is utilized for the segmentation network to extract the region of interest(ROI)from otoscopic images.The extracted ROIs are used as guiding features for the classification.The classification is based on transfer learning with an ensemble of two CNN classifiers:EfficientNetB0 and Inception-V3.The proposed model was trained with a 5-fold cross-validation technique.The proposed method was evaluated and achieved a classification accuracy of 97.29%.

两种生活质量量表在慢性化脓性中耳炎中的差异比较

目的使用慢性中耳炎疗效调查量表(chronic otitis media outcome test,COMOT-15)和苏黎世慢性中耳炎量表(Zurich chronic middle ear inventory,ZCMEI-21)评估慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)及中耳胆脂瘤患者健康相关生活质量(health-related quality of life,HRQoL)的总体情况,比较两份问卷相关性及差异。方法回顾性选取2020年5月—2022年5月在兰州大学第二医院耳鼻咽喉头颈外科行手术治疗的101例CSOM和中耳胆脂瘤患者为研究对象,采用COMOT-15及ZCMEI-21,结合患者性别及气导平均听阈(air conduction-pure tone average,AC-PTA)比较患者的HRQoL,采用Cronbach'sα评价内部一致性并作为信度指标,使用Pearson相关性分析量表之间的相关性及与患耳AC-PTA间的相关性,使用Mann-Whitney U检验探究性别与量表间的相关性。结果101例患者两种量表得分均呈正态分布,除COMOT-15耳部症状维度(Cronbach'sα=0.602)和ZCMEI-21耳部症状维度(Cronbach'sα=0.473)外,两份问卷总维度和子维度均表现出满意的内部一致性。CO-MOT-15和ZCMEI-21的总维度与子维度之间存在中等到强的相关性;术侧患耳AC-PTA与两份量表总维度、耳部症状、听力、社会心理维度之间存在较好的相关性;耳部症状维度与两份量表总维度、听力、社会心理维度之间存在较好的相关性;COMOT-15和ZCMEI-21在性别方面存在不同程度的差异。结论两种量表具有较高的内部一致性、强相关性,但侧重点不同。COMOT-15侧重听力,涉及不同场景下的听力情况,适合以听力为重点的研究。ZCMEI-21提供了慢性中耳炎耳部症状的综合评估,如眩晕、耳流脓等症,在社会心理、就医问题上,更能反映患者心理健康及对医疗需求的真实情况,同时应严格规范量表的时间窗以确保数据的真实有效性。

慢性化脓性中耳炎的微生物学研究进展

慢性化脓性中耳炎(CSOM)是一种常见病多发病,CSOM是一种多因素疾病,由环境、细菌、宿主和遗传危险因素等一系列因素相互作用引起,细菌感染是CSOM重要的原因之一。由于地区、民族、饮食习惯等差异,CSOM在世界各地的发病率及细菌种类也有所差异。既往基于培养技术获得CSOM部分优势菌群,但不能获得CSOM细菌群落的全貌,限制了CSOM的病原学研究。随着各项检测技术的提高,特别是16S rRNA测序及宏基因组测序等分子技术的发展,CSOM病原学研究也逐步完善,这不仅对抗生素的选择提供依据,同时也能进一步研究细菌在CSOM中的致病机制。

慢性化脓性中耳炎鼓膜穿孔特征与听力损失的相关性研究

目的探讨慢性化脓性中耳炎鼓膜穿孔特征与听力损失的相关性。方法回顾性分析2022年7月~2023年7月于兰州大学第二医院耳鼻咽喉头颈外科确诊为慢性化脓性中耳炎并行Ⅰ型鼓室成形术治疗的80例患者(104耳)的纤维耳内镜图像及完整的听力学资料。采用ImageJ图像软件测量鼓膜穿孔面积,以穿孔边界面积占完整鼓膜边界面积的百分比(RAp值)为鼓膜穿孔相对面积。分析不同面积鼓膜穿孔、穿孔涉及象限、穿孔边缘是否钙化以及穿孔范围是否累及锤骨柄与气骨导差(ABG)的关系。结果慢性化脓性中耳炎鼓膜穿孔患者的鼓膜穿孔面积与平均气骨导差之间呈显著正相关关系(R^(2)=0.141,P<0.0001),相对穿孔面积越大者ABG越大;穿孔累及锤骨柄的患者较未累及锤骨柄的患者气骨导差更大(P<0.05);鼓膜穿孔边缘钙化情况和穿孔位置对听力损失的影响很小,几乎可以忽略不计。结论鼓膜穿孔引起的传导性听力损失与穿孔大小和穿孔是否累及锤骨柄有关,穿孔相对面积越大及穿孔累及锤骨柄患者的传导性听力损失往往更重。

76例急性化脓性中耳炎患儿耳分泌物的病原菌分布情况及药敏结果分析

目的探究急性化脓性中耳炎患儿耳分泌物的病原菌分布情况及药敏结果。方法选取2018年1月—2023年5月武汉儿童医院接诊的76例急性化脓性中耳炎患儿,采集中耳分泌物行病原学培养及药敏试验检测,分析致病菌分布特征及药敏结果,并分析主要感染菌种的耐药性变迁结局。结果76例患儿共检出病原菌84株,肺炎链球菌和金黄色葡萄球菌的占比较高,分别为71.43%和23.81%。1个月~1岁、>1~3岁、>3~8岁患儿肺炎链球菌感染率分别为40.00%、35.00%和25.00%,金黄色葡萄球菌感染率分别为25.00%、30.00%和45.00%。肺炎链球菌对左旋氧氟沙星的耐药性2018~2019年低于2022~2023年(P<0.05)。肺炎链球菌对阿奇霉素、四环素和克林霉素的耐药性较高,分别为81.67%(49/60)、90.00%(54/60)和66.67%(40/60);对万古霉素和利奈唑胺的敏感性最高,耐药率均为0.00%;对氯霉素、厄他培南和奎奴普丁/达福普汀的耐药性较低,分别为8.33%(5/60)、13.33%(8/60)和10.00%(6/60);对左旋氧氟沙星、美罗培南、复方新诺明、头孢噻肟、头孢曲松、头孢吡肟和青霉素均存在不同程度的耐药性,耐药率为21.67%~48.33%。金黄色葡萄球菌对左旋氧氟沙星、头孢吡肟、阿奇霉素、四环素和克林霉素的耐药性较高,分别为70.00%(14/20)、65.00%(13/20)、65.00%(13/20)、90.00%(18/20)和70.00%(14/20);对万古霉素、利奈唑胺的敏感性最高,耐药率均为0.00%;对氯霉素和奎奴普丁/达福普汀的耐药性较低,均为5.00%(1/20);对美罗培南、复方新诺明、头孢噻肟、头孢曲松、青霉素和厄他培南均存在不同程度的耐药性,耐药率为20.00%~50.00%。结论急性化脓性中耳炎患儿的病原菌分布中以肺炎链球菌和金黄色葡萄球菌占比最高,药敏试验得出两者对阿奇霉素、四环素及克林霉素的耐药性偏高,而对氯霉素、万古霉素、利奈唑胺、厄他培南及奎奴普丁/达福普汀的耐药性相对较低。

Treg细胞抑制慢性中耳炎模型小鼠中耳炎症的进展

目的探究慢性中耳炎(chronic otitis media,COM)小鼠中Treg细胞与炎症发展之间的关系。方法采用不可分型流感嗜血杆菌(NTHi)腹腔注射和中耳咽鼓管(ET)阻断的方式诱导构建慢性中耳炎小鼠模型(模型组),选择健康BALB/c小鼠作为对照组。分别在建模后第3,14,28,56天分离收集小鼠中耳积液和中耳黏膜组织,通过苏木精-伊红(HE)染色检测MEM病理变化,采用免疫组织化学染色评估CD4^(+)和Foxp3^(+)T细胞水平,ELISA和Western blot分别检测小鼠中耳积液和中耳黏膜组织中肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-1β、IL-10和转化生长因子(TGF-β)水平,流式细胞术分析CD4^(+)CD25^(+)Foxp3^(+)细胞比例。另取COM模型小鼠分为PBS组和抗-CD25组。抗-CD25组小鼠腹腔注射抗CD25 mAb模拟体内Treg耗竭,PBS组小鼠腹腔注射等量PBS溶液,第56天收集小鼠中耳积液、中耳黏膜组织、脾脏和颈部淋巴结组织,检测分析脾脏、颈部淋巴结和中耳黏膜组织中CD4^(+)CD25^(+)Foxp3^(+)细胞比例,中耳黏膜组织中炎性因子水平,以及中耳积液中细菌水平。结果HE结果显示,对照组小鼠中耳黏膜组织正常,模型组小鼠中耳黏膜组织出现炎性细胞浸润,细菌数量、炎性细胞数量和黏膜厚度均增加(P<0.05)。与对照组比较,模型组小鼠中耳黏膜组织中CD4^(+)CD25^(+)Foxp3^(+)细胞比例升高(P<0.05),中耳积液和中耳黏膜组织中炎性因子IL-1β、TNF-α、IL-10和TGF-β的水平均升高(P<0.01)。与PBS组比较,抗-CD25组小鼠中耳黏膜组织、脾脏和颈部淋巴结组织中CD4^(+)CD25^(+)Foxp3^(+)细胞比例均降低(P<0.05),中耳积液中细菌数和中耳黏膜组织中炎性因子IL-1β、TNF-α、IL-10和TGF-β的水平均降低(P<0.01)。结论Treg细胞在慢性中耳炎的炎症平衡维持中具有重要作用,抑制炎症的进展,但过度的Treg细胞抑制了宿主对细菌的清除作用。