MEPD after TT insertion

TT 插入后的 MEPD

• 批准号: 7657385
• 负责人: ELLEN M MANDEL
• 金额: $ 17.33万
• 依托单位: CHILDREN'S HOSP PITTSBURGH/UPMC HLTH SYS
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7657385
• 关键词: 3 year old; Bolus Infusion; Bypass; Child; Clinical; Clinical Research; Condition; Constitutional; Data; Disease; Ear; Economic Inflation; Edema; Enrollment; Equilibrium; Eustachian Tube; Feedback; Frequencies; Functional disorder; Gases; Healed; Human; Individual; Inflammation; Longitudinal Studies; Measurement; Measures; Medical; Methods; Modeling; Mucous Membrane; Noble Gases; Otitis Media; Otitis Media with Effusion; Otorrhea; Pathogenesis; Patient observation; Patients; Phase; Protocols documentation; Rate; Recurrence; Regulation; Research Personnel; Resolution; Risk; Solid; Testing; Time; Tube; Tympanostomy; Tympanostomy Tube Insertions; aged; concept; disorder prevention; effusion; expectation; healing; mathematical model; middle ear; pressure; prevent; programs; theories

MIDDLE EAR PRESSURE DEREGULATION AFTER TYMPANOSTOMY TUBE INSERTION Perhaps the most well supported clinical evidence for our model of Otitis Media with Effusion (OME) pathogenesis by middle ear (ME) pressure disregulation is the documented positive effect of tympanostomy tube (TT) insertion in preventing and resolving OME episodes. Because TTs bypass the Eustachian tube (ET) to maintain ambient ME pressure, these observations suggest that adequate ME pressure-regulation and not other suggested functions of the ET is prerequisite for disease resolution. Longitudinal studies show that after TT insertion in MEs with OME, the volume of the ME airspace progressively increases which correlates with decreasing ME inflammation and effusion volume. Our mathematical model shows that these changes should be reflected as lesser rates of gas exchange across the ME mucosa which are realized as a decreased demand placed upon the ET for gas resupply. In the proposed study, we will enroll children aged 3 years and older with TTs inserted for OME and measure the ME gas demand, ME volume and ETF longitudinally between TT insertion and extrusion, and then follow the enrolled patients for disease recurrence after TT extrusion. These results will be used to test the hypotheses that: 1) gas transfer across the ME mucosa (MEM) decreases in phase with resolution of ME inflammation and effusion; 2) gas transfer across the MEM is increased by an episode of otorrhea; 3) ETF is unaffected by TT insertion, and 4) measurement of ETF and transMEM gas transfer (supply/demand balance) predicts disease recurrence and presentation after TT extrusion. The results of these studies will be used to support or refute tested components of our model of ME pressure-regulation and to develop test protocols for risk assignments with respect to disease recurrence in individual ears after TT extrusion.

插入鼓膜造口管后中耳压力放松 也许是我们的渗出性中耳炎 (OME) 模型最有力的临床证据 中耳 (ME) 压力失调的发病机制是鼓膜造口管的积极作用 (TT) 插入预防和解决 OME 事件。因为 TT 绕过咽鼓管 (ET) 维持环境 ME 压力，这些观察结果表明，充分的 ME 压力调节而不是其他 ET 的建议功能是疾病解决的先决条件。纵向研究表明，TT 后 通过 OME 插入 ME，ME 空域的体积逐渐增加，这与 减少 ME 炎症和渗出量。我们的数学模型表明这些变化应该 反映为穿过 ME 粘膜的气体交换率较低，这是由于需求减少而实现的 放置在 ET 上进行气体补给。在拟议的研究中，我们将招募 3 岁及以上的儿童 为 OME 插入 TT，并在 TT 之间纵向测量 ME 气体需求、ME 量和 ETF 插入和拔出，然后跟踪入组患者 TT 拔出后的疾病复发情况。这些 结果将用于检验以下假设：1) 穿过 ME 粘膜 (MEM) 的气体传输减少 ME 炎症和渗出消退阶段； 2）通过MEM的气体传输增加了 耳漏发作； 3) ETF 不受 TT 插入的影响，4) ETF 和 transMEM 气体的测量 转移（供需平衡）可预测 TT 挤出后疾病的复发和表现。结果 这些研究中的一部分将用于支持或反驳我们的 ME 压力调节模型的测试组件 制定 TT 后个体耳朵疾病复发风险分配的测试方案 挤压。