刘光华

[摘要]分泌性中耳炎发病机制尚不明确，咽鼓管功能不良和感染学说是其主要病因。对分泌性中耳炎的治疗还没有确切的方案，主要有药物和手术治疗，药物治疗有抗生素、糖皮质激素和表面活性物质等，手术治疗常用的有鼓膜穿刺、鼓膜切开置管、鼓膜造孔等，近年流行的咽鼓管球囊扩张及电子鼻咽喉镜或鼻内镜下咽鼓管注药亦取得了较好的疗效。维持中耳内外气压平衡，恢复咽鼓管正常的生理功能是其治疗的重点和关键。运用现代科学技术研究出卡介苗、细胞因子拮抗剂以预防和治疗分泌性中耳炎是以后进一步研究的方向。

[关键词]分泌性中耳炎；咽鼓管；治疗；新进展

[中图分类号] R764.21 [文献标识码] A [文章编号] 1674-4721（2016）09（b）-0012-04

[Abstract]Pathogenesis of secretory otitis media is not clear，poor eustachian tube function and infection theory are the main causes of disease，the treatments of secretory otitis media have no definite solution，there are drugs and surgery，drug therapy include antibiotics，corticosteroids and surface-active substances etc.，commonly used surgical treatment methods have tympanic membrane puncture，myringotomy with grommet insertion，tympanostomy etc.，in recent years，popular eustachian tube balloon and video laryngoscope or endoscopic injection in eustachian also have made a better clinical outcome.To maintain the pressure balance inside and outside the middle ear，that eustachian tube restored normal physiological function is the key to its treatment.Investigative BCG vaccine，cell factor antagonists by using the modern science and technology in the prevention and treatment of secretory otitis media are the direction of further research in the future.

[Key words]Secretory otitis media；Eustachian tube；Treatment；New progress

分泌性中耳炎（secretory otits media，SOM）是以中耳积液及听力下降为主要特征的中耳炎性疾病，根据鼓室积液性质的不同，有渗出性中耳炎、浆液性中耳炎、卡他性中耳炎、黏液性中耳炎、中耳积液、咽鼓管炎及胶粘耳等不同叫法。其真正病因及发病机制目前尚不清楚，但大部分学者认为咽鼓管黏膜肿胀、管腔阻塞是其主要病因，因而治疗的关键也是保护和恢复咽鼓管的正常生理功能，恢复中耳的通气功能，促进鼓室积液的排出。如延误治疗可发展成为慢性SOM，慢性SOM易致听力损失，并且容易出现鼓室硬化、萎缩等并发症[1]。目前，对SOM的治疗还没有确切的方案，常用的有药物治疗和手术治疗。现将近年来治疗SOM的有关文献综述如下。

1主要病因