| Objective:Secretory Otitis Media(SOM)is a non-suppurative disease of middle ear,which characterized by the middle ear effusion and hearing loss.The clinical symptoms of it are ear blockage,hearing loss,or tinnitus and earache.There is no standard and optimal treatment.Drugs and operations are normal elections in daily clinical work.However,there are several defects in the above-mentioned approaches.Some drugs would give rise to medicine tolerance and side effects.Operations usually bring about high risks.Western medicine usually deals with the symptoms,while traditional Chinese medicine treats this disease in a way which not only integrates holistic concept with the four diagnostic methods,but also combines disease and syndrome.Several researches have shown the apparent efficacy of the traditional Chinese medicine.Quyuan Decoction comes from "Differentiation Anecdote".Tutor combined the theoretical knowledge with practical experiences to add ephedra,almond,licorice and chenpi to Quyuan Decoction,so that the Jiawei Quyuan Decoction was formulated and used to treat Allergic Rhinitis,Secretory Otitis Media and Rhinosinusitis.The decoction was used for several years and gains obvious positive effects.This study aimed to evaluate the clinical of Jiawei Quyuan Decoction in the treatment of secretory otitis media.The influences of this decoction on Th1/Th2,AQP-1 and TNF-? in rat model were also in the spectrum of the study.Method:1.Evaluation of Clinical efficacy:A total of 60 patients with secretory otitis media were randomly selected,who met the inclusion criteria and diagnosed both western and traditional SOM(the TCM type was external pathogenic factors attacking)in the Otolaryngology department of Nanjing Integrated Traditional Chinese And Western Medicine Hospital,from December 2018 to June 2019.They were assigned to two groups at an equal distribution,the treatment and control group.The control group patients were given the basic clinical treatment,Cefuroxime Axetil tablets 0.25g twice a day and Olongma Drops 5ml each time three times a day.The treatment group patients were given Jiawei Quyuan Decoction on the basis of the treatment mentioned above.One dose a day,morning and evening.The course of the treatment sustained about fortnight.This study would evaluate the total efficacy of this decoction in some aspects as shown as follows:the quantitative score of symptoms and signs,appraisal of efficacy,pure tone threshold measurement and acoustic impedance.In addition,the serums were collected and detected before and after the treatment to test the Interleukin-4(IL-4)and Interferon-gamma(IFN-?)in that the Thl/Th2 could be counted.Based on the results above,the effects of regulation of the decoction could be probed.2.Evaluation of efficacy in rat model:Thirty clean Sprague-Dawley rats were randomly and equally divided into three groups,which were the treatment group,the control group and the model group.We set rat model of secretory otitis media in a way which was abdominal injection integrated intratympanic injection with ovalbumin.After the model were set successfully,the control group rats were treated with Cefuroxime Axetil tablets lml/100g and Olongma Drops 1.575ml/kg once a day.The treatment group rats were treated with Jiawei Quyuan Decoction 1ml/l00g once a day on the basis of the treatment mentioned above.Both the courses would sustained fortnight.The model rats were treated nothing and executed when the models were set up successfully.To test the level of IL-4,IFN-?,Aquaporin-1(AQP-1)and Tumor Necrosis Factor-a(TNF-?)of samples.It provided reliable basis to explore the efficacy of Jiawei Quyuan Decoction in the treatment of SOM in rat model.Results:1.Evaluation of Clinical efficacy:(1)After two weeks,the overall efficacy of treatment group is 93.33%,and the control group was 90.00%.(2)Both groups has great positive effects in ear blockage,hearing loss and earache,and the treatment has an advantage over the other group.(3)The treatment group has significant strengths over the other group when it comes to pure tone threshold measurement.However,there is no great distinct between groups on acoustic impedance.(4)Both groups can improve the level of IL-4,IFN-y and Thl/Th2.The treatment group did much better in regulating the level of IL-4 and Thl/Th2 compared to the control group.2.Evaluation of efficacy in rat model:(1)Both groups can improve the level of IL-4,IFN-y and Thl/Th2 when they were compared with that of the model group.The treatment group did much better in regulating the level of IL-4 and Thl/Th2 compared to the control group.(2)Both the treatment and control group could improve the level of TNF-? and AQP-1 when they were paralleled to the model group.Also the treatment group showed a conspicuous advantage over the control group.Conclusion::1.Jiawei Quyuan Decoction combined with Cefuroxime Axetil and Olongma Drops due has a great effect in the treatment of SOM.2.Jiawei Quyuan Decoction effectively relieves the subjective symptoms,especially the ear blockage and hearing loss.It can abate the level of IL-4 to correct the balance of Thl/Th2.3.By the evaluation in rat model,Jiawei Quyuan Decoction can enhance the secretion of AQP-1,correct the balance of Thl/Th2 and restrain the level of TNF-?.With the merits above,middle ear effusion can be absorbed notably and negative pressure in middle ear can be corrected greatly. |
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