The Analysis of the Gas Tension and Effect of the Tympanostomy Tube in Otitis Media with Effusion.
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概要
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We measured the partial gas pressure in the middle ear cavity (MEC) of 34 ears with otitis media with effusion (OME) by the mass spectrometry, whose results of tympanometry were consistent with types B and C. The 34 ears consisted of 11 ears immediately after incision on the tympanic membrane (TM) and 23 ears improved by insersion of the tympanostomy tube.<BR>We also recorded changes in pressure in the MEC, using a pressure measurement apparatus coupled with an otoscope, after incision of the TM in 9 cases of type B and 6 cases of type C with OME. When the MEC of these patients were opened up by TM incision or insertion of the tympanostomy tube, pressure in the cavity increased to above atomospheric pressure.<BR>Based on our understanding of the physiology of ventilation in the bodily cavities in general, we found that ventilation of the MEC, though destroyed by the disease process, was temporarily restored by TM incision or insersion of the tympanostomy tube, and that the ventilation facilitated gas exchange across the mucosal membrane of the MEC to increase its capacity to ventilate.<BR>In the MEC of patients with tympanometric type B and C, as CO<SUB>2</SUB> gas dissolved into the exudate covering the MEC, the internal pressure became negative and HCO<SUB>3</SUB> ions in the exudate increased. We suggest that this increase in HCO<SUB>3</SUB>in the exudate interferes with the function of the mucosal membrane to produce gas and results in structural changes.<BR>With TM incision or insersion tympanostomy tube, we may be able to resume ventilation of the MEC through the external auditory canal and the impaled TM.<BR>However, we believe that OME with a functional impairment of the auditory tube may be resistent to these treatment modalities and may be better treated using alternative measures to improve the function of the auditory tube.
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