Study Of Nasopharyngeal Surfactant In Cleft Palate With Secretory Otitis Media Patients

Background and purpose: secretory otitis media(SOM) is a kind of middle ear effusion and non-acute infection characterized by a common and a high incidence in children, normal incidence 10% . Cleft palate ( CP) is a SOM of the high-risk groups, incidence rates are much higher than the normal population, reported in the literature, the incidence rate of SOM in patients with cleft palate can be as high as 70% to 100%, and the age of cleft palate patients smaller, SOM higher prevalence, the prevalence rate of less than 1 year of age up to 94%【1 ~ 3】. SOM often result in hearing loss, delayed language development and cause acute otitis media. Cleft palate patients with one hand, as anatomical structure of abnormal loss of normal speech, on the other hand, lead to hearing loss to hear sound distortion, increase the developmental disorders of speech. Middle ear function in cleft palate patients has been increasing attention, conventional sequential therapy in patients with cleft palate also the prevention and treatment of SOM proposed new requirements. Current methods are mainly Cleft Palate, tympanic membrane and tympanic puncture catheterization. But the treatment is still controversial, and easy to relapse after surgery and cause permanent ear drum perforation, ear drum hardening, cholesteatoma, a series of complications such as adhesive otitis media. Recent studies show that the Surface active substance (SAS) deficiency is an important factor in the pathogenesis of normal SOM. SAS exist in the eustachian tube and middle ear cavity, it can reduce the surface tension of the anti-adhesion mechanism by which to make more open the eustachian tube. Application to the rat middle ear exogenous surfactant significantly reduced the eustachian tube opening pressure, clinical trials of oral ambroxol (a kind surfactant can increase the material) can reduce the incidence of SOM【4】. SOM currently considered the occurrence of cleft palate patients mainly because of its anatomical abnormalities palate, velum interrupted the continuity tensor can not be effective to the eustachian tube open so that the middle ear effusion accumulation. But many scholars have found, although some of cleft palate patients after palatoplasty Tympanotomy, postoperative hearing recovery is still not ideal, we need to find more effective treatment. Based on this study, nasopharyngeal surfactant reducing vulnerability to SOM, exogenous surfactant use is effective in treating SOM, SOM reference to other scholars in patients with normal nasopharyngeal Determination of surfactant was measured SOM nasal cleft palate pharyngeal lavage content of surfactant, and discuss the high incidence of cleft palate patients with the relationship between the SOM. Methods: Detection of the acoustic impedance of cleft palate patients and tympanic membrane puncture, clear SOM patients. Healthy people were collected, cleft palate and cleft palate in patients with non-SOM SOM in patients with nasopharyngeal fluid, with a spectrophotometer on behalf of surfactant lecithin content, and compared.Results: 1,30 cases of cleft palate patients (60 ears) were conducted tympanometry examination, of which 20 ears (33.34%) for the normal type A tympanogram, 33 ears (55%) were type B tympanogram, 7 ears (11.67%) for the C-type tympanogram and abnormal tympanogram type B + C type, 40 ears (66.67%), cleft palate patients with SOM for 22 cases (37 ears), the prevalence was 73.34% .2,cleft palate patient group with SOM on behalf of the nasopharyngeal lavage surfactant lecithin content (9.0760±2.4390) mg / L , cleft palate patients with non-SOM group (13.1005±2.5746) mg / L and normal control group (55.8925±8.6462) mg / L were more significantly reduced (P <0.05), cleft palate and cleft palate patient group with non-SOM SOM group also decreased significantly (P <0.05).3,increased with age in patients with cleft palate, nasopharyngeal surfactant content increased, but 12 years ago was no significant difference, after 12 years were significantly different (P <0.05), while the prevalence of SOM decreased.4,cleft type on nasopharyngeal surfactant content and the prevalence rate had no effect on SOM.Conclusion: Nasopharyngeal surfactant can indirectly reflect the ear, eustachian tube inner surface of the active substance level, and affect eustachian tube function. Cleft palate patients with nasopharyngeal surfactant lower than the control group, less than cleft palate cleft palate patients with SOM in patients with non-SOM group, and increased with age, the nasopharyngeal surfactant content increased, SOM prevalence rate. Tips cleft palate in addition to anatomical damage, reduce nasopharyngeal surfactant may also be the reason for high incidence of SOM. In Cleft Palate, based on early application of cleft palate patients attempt to exogenous surfactant, to reduce the incidence of SOM to improve hearing function in patients with cleft palate, cleft palate speech in order to facilitate functional recovery.