慢性中耳炎伴积液中胃食管反流引起的中耳粘膜转化特征

M. V. Komarov, A. A. Fedotova, E. Bezrukova, R. F. Galeev
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摘要

简介慢性中耳炎伴渗出液(COME)是一种中耳疾病,其特点是中耳结构内有粘液渗出物积聚。胃液反流是慢性中耳炎形成的重要机制之一。胃内容物反流进入鼓室,导致鼓室粘膜发生不可逆转的变化。证实胃液反流在中耳粘膜纤维重塑中的重要性。该研究纳入了 96 名确诊为 COME 并伴有胃食管反流病(GERD)的患者,其中女性 54 人,男性 42 人,年龄在 18 岁至 65 岁之间(平均年龄 51.4 岁)。所有患者均接受了鼓室造口术,并在耳鼻喉科医生的指导下进行了为期 12 个月的治疗。根据患者是否同意接受胃食管反流治疗,将其分为两组。对 COME 和胃食管反流病的保守治疗是根据现行的医疗标准和相关疾病的临床指南进行的。鼓室造口术后 14 天,主要组中的 31 人(75.6%)和对比组中的 31 人(56.6%)(n = 96)发现耳鸣减少。两组患者(n = 82)中分别有 35 人(83.3%)和 25 人(62.5%)获得了积极的疾病结果,如渗出减少和鼓膜完全修复(n = 82)。在疾病的早期阶段,感染性病原体的暴露会导致黏膜渗出活跃,而混合性和非酸性胃反流则会导致黏膜中耳纤维重塑。研究还证实,在没有胃食管反流治疗的情况下,COME 治疗不成功会加重疾病的结果。
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The GERD-caused middle ear mucous membrane transformation features in chronic otitis media with effusion
Introduction. Chronic otitis media with effusion (COME) is a middle ear disease, characterized by mucous effusion accumulation in its structures. One of the important COME formation mechanism is gastric reflux. Gastric contents reflux into the tympanic cavity which contributes to the irreversible transformation of its mucous membrane.Aim. To substantiate the significance of the gastric reflux in the middle ear mucosa fibrous remodeling.Materials and methods. The study included 96 people diagnosed with COME and concomitant gastroesophageal reflux disease (GERD), 54 women and 42 men, in the age range from 18 to 65 years (mean age 51.4 years). All patients underwent tympanostomy tube installation and supervised by an otolaryngologist during 12 months. Patients were divided into 2 groups depending on their consent to GERD therapy. The conservative treatment of COME and GERD was carried out in accordance with established and current medical care standards and clinical guidelines for the relevant nosology.Results and discussion. 14 days after the tympanostomy, the otorrhea decrease was noted in 31 (75.6%) of the main group and 31 (56.6%) participants in the comparison group (n = 96).By the end of 12 months observation a positive disease outcome such as exudation reduction and complete tympanic membrane repair was recorded in 35 (83.3%) and 25 (62.5%) patients of both groups respectively (n = 82).Patients with a mixed 34 (35.4%) and non-acid 11 (11.5%) types of reflux showed worse disease outcome rates, just like in patients with COME who delayed GERD treatment 8 (8.3%).Conclusions. The combination of infectious agent exposure causes an active mucous membrane exudation in the disease early stages with mixed and non-acid gastric reflux leads to mucous membrane middle ear fibrous remodeling. It has also been established that an unsuccessful COME treatment duration aggravates the outcome of the disease in the absence of GERD therapy.
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