サーファクタント様物質と滲出性中耳炎(総説)

Abstract

The cause of OME (otitis media with effusion) is not clearly known, but many studies indicate that dysfunction of the eustachian tube plays a role in its pathogenesis. The potential existence of a STLS (surface tension lowering substance) in the middle ear cavity which facilitates the opening of the eustachian tube was first postulated by Bauer in 1970.Appreciable phospholipids were shown to be present in eustachian tube lavage fluid by many investigators. The major components of pulmonary surfactant are phospholipids, especially DSPC (dipalmitoyl phosphatidylcholine). We also detected the existence of DSPC in middle ear effusions.Monoclonal antibodies against pulmonary surfactant protein were prepared by Kuroki et al. We found fine positive granules in the mucosal epithelial cells of the middle ear, while Lamellar bodies were found in the secretory cells of the middle ear by electromicroscopic examinations.Yamanaka et al reported that the positivity of SAP (surfactant apoprotein) in middle ear effusions showed a good correlation with the clinical course of OME, and the period of observation of SAP-positive cases being significantly shorter than that of SAP-negative cases.Some investigators have suggested the efficacy of treating OME with artificial pulmonary surfactant. Kobayashi et al reported that the use of artificial surfactant was effective for patients with OME.