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第一页，共二十七页。分泌性中耳炎〔OME〕是以鼓室积液和传导性听力下降为主要特征的中耳非化脓性炎症Catarrhalinflammationofmiddleearcleftthatcharacterizedbymiddleeareffusionandconductivehearingloss.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OMEisdefinedasMEEwithoutsignsandsymptomsofacuteinflammation(otalgia,irritability,andfever;bulgingofthetympanicmembrane)概述第二页，共二十七页。儿童、婴幼儿听力下降的主要原因之一OneofthemostimportantfactorthataffectingtheChildren’shearing儿童OME确切的发病率不详，因本病通常无明显临床病症。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Itmaybedifficulttodeterminethe“true〞incidenceofOMEbecause,bydefinition,OMEisasymptomatic.However,nearlyallchildrenhadexperiencedatleastoneepisodebytheageof3years第三页，共二十七页。Variousfactorsinteractinthepathogenesisofotitismedia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第四页，共二十七页。咽鼓管(ET)-中耳(ME)-乳突(mast)通气系统在OME发病中的作用.Thethreephysiologicfunctionsoftheeustachiantubeare(1)pressureregulation(ventilation),(2)protection,and(3)clearance(drainage).Ofthese,pressureregulationisthemostimportantA,Pressureregulationfunctionisrelatedtoactivedilationofthetubebycontractionofthetensorvelipalatinimuscle(TVP).第五页，共二十七页。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发生率明显下降第六页，共二十七页。中耳积液的细菌学研究Comparisonofdistributionofisolatesin2807effusionsfrompatientswithacuteotitismedia(AOM)and4589effusionsfrompatientswithotitismediawitheffusion(OME)atthePittsburghOtitisMediaResearchCenter,1980to1989.Totalpercentagesaregreaterthan100%becauseofmultipleorganisms第七页，共二十七页。现有研究认为:OME可能起源于慢性感染SecretorychangesinthemiddleearinCOMEaremostlikelyduetochronicinfection多数患者以急性感染起病Themajorityofcasesbeginasacuteinfectionofthemiddleear咽...
