猫非息肉相关中耳炎:我们所知道的

王帆

Nonpolyp-associated otitis media in cats: The little we know

猫非息肉相关中耳炎:我们所知道的

翻译：王帆

Otitis media (OM) is characterised by inflammation and infection in the middle ear. Despite being a common condition in cats, the pathogenesis of OM is not well understood. The known causes of middle ear disease (MED) in cats are inflammatory polyps, neoplasia and extension of external ear canal infection into the middle ear. Auditory tube obstruction or dysfunction secondary to nasal or upper respiratory disease and rarely haematogenous spread are suggested causes of MED with effusion.

中耳炎(OM)的特征是中耳炎症反应和感染。虽然OM是猫的一种常见疾病，但其发病机制尚不清楚。猫中耳疾病(MED)的已知病因是炎性息肉、肿瘤和外耳道感染延伸至中耳。咽鼓管阻塞或功能异常继发于鼻部或上呼吸道疾病，以及罕见的血源性扩散是MED伴有积液的病因。

 

The association between MED and nasal disease on computed tomography (CT) scans in cats has been documented previously. The prevalence of bulla effusion in cats with sinonasal disease was 28% (13/46) and was significantly higher than that observed in cats without sinonasal disease (1/18). In another study, 27 of 34 cats (79%) had concurrent nasal disease . Experimental obstruction of the auditory tube causes a decrease in the middle ear ciliary area, decreased secretion clearance and middle ear effusion. This model potentially mimics some nasal and upper respiratory diseases in which mucosal inflammation and temporary auditory tube obstruction result in middle ear effusion. Viral upper respiratory tract infections may predispose patients to bacterial colonisation of the nasopharynx and ascending bacterial middle ear infection via the auditory tube. For those cats, recurrence of OM can occur if the nasal or upper respiratory disease is not well controlled. As most of the time, viral infections are the primary cause of these upper respiratory diseases in cats, adequate control of the upper respiratory disease is difficult. In the previously mentioned study, eight of the 25 cats with rhinitis had concurrent OM, including 2/2 cats with lymphoplasmacytic rhinitis, 4/14 with neutrophilic rhinitis and 2/8 with mixed inflammatory rhinitis. CT evidence of sinusitis and nasopharyngeal disease was positively correlated with the finding of OM. The implications of these findings for the management of cats with sinonasal disease require further investigation.

在猫的计算机断层扫描(CT)上，MED和鼻部疾病之间的联系以前已经有文献记载。有鼻窦疾病的猫鼓泡积液的发病率为28%(13/46)，显著高于没有鼻窦疾病的猫(1/18)。在另一项研究中，34只猫中有27只(79%)同时患有鼻部疾病。试验性咽鼓管阻塞导致中耳纤毛面积减少，分泌物清除减少和中耳积液。该模型潜在地模拟了一些鼻腔和上呼吸道疾病，即粘膜炎症反应和暂时性咽鼓管阻塞导致的中耳积液。病毒性上呼吸道感染的患病动物易出现鼻咽细菌定殖和经咽鼓管上行至中耳的细菌感染。对于这些猫来说，如果鼻腔或上呼吸道疾病没有得到很好的控制，可能会发生OM复发。大多数情况下，病毒感染是引起猫上呼吸道疾病的原发病因，因此充分控制上呼吸道疾病有难度。在前面提到的研究中，25只患有鼻炎的猫中有8只同时患有OM，其中2/2只患有淋巴浆细胞性鼻炎，4/14只患有中性粒细胞性鼻炎，2/8只患有混合性炎性鼻炎。鼻窦炎及鼻咽部疾病的CT表现与OM的发现呈正相关。这些发现对患有鼻窦疾病的猫的管理的影响需要进一步的研究。

 

In a study of imaging evaluation of the middle ear, five of 84 cats (6%) were excluded as normal controls because they had fluid in the tympanic bulla. Another study showed that 34 of 101 cats (34%) did not have clinical signs of OM or physical findings consistent with ear disease, suggesting that MED was subclinical. Subclinical MED was relatively frequent in cats undergoing CT imaging of the head. Few cats had subsequent treatment for ear disease, suggesting that treatment may not be necessary, although follow-up was limited in this study. At this time, it is not known if treatment is important for these cats and if asymptomatic OM can progress to become symptomatic.Chronic OM with effusion is thought to be associated with chronic inflammatory changes in the middle ear leading to abnormal fluid secretion by the membrane lining the tympanic bullae and auditory canal.

在一项关于中耳影像评估的研究中，84只猫中有5只(6%)被排除在正常对照组之外，因为它们的鼓泡中有液体。另一项研究表明，101只猫中有34只(34%)没有OM的临床症状，或体格检查也没有发现耳病表现，这表明MED是亚临床表现。亚临床MED在猫头部CT影像检查中相对常见。虽然很少有猫对耳病进行后续治疗，提议可能没有必要进行治疗，但本研究缺乏随访信息。目前，尚不清楚治疗对这些猫是否重要，以及无症状的OM是否会发展为有症状的OM。慢性中耳炎伴积液被认为与中耳慢性炎症改变有关，导致鼓泡和咽鼓管内衬粘膜异常分泌液体。

 

The percentage of cats that present with symptomatic OM without otitis externa (OE) and upper respiratory signs is lacking in the literature. In a study that evaluated 16 cats with OM, half of the cats showed signs of OE on presentation, and three cats presented with upper respiratory signs, while the other five cats (31%) presented symptomatic OM without OE and/or upper respiratory signs. The auditory tube dysfunction could be a potential cause as well as haematogenous spread or viral infections; however, further studies are needed.

关于猫有OM症状但没有外耳炎(OE)和上呼吸道症状的发病率缺乏文献报答。在一项评估16只患有OM的猫的研究中，一半的猫有OE表现，3只猫表现出上呼吸道症状，而其他5只猫(31%)表现出OM症状同时无OE和/或上呼吸道症状的症状。咽鼓管功能障碍可能是潜在病因，也可能是血源性传播或病毒感染。然而，还需要进一步的研究。

 

OM can either be managed medically or surgically. Since the cause is often unknown, deciding on the ideal treatment protocol can be challenging in some cases. Myringotomy followed by middle ear flushing and therapy with glucocorticoids and antibiotics, if bacterial infection is present, have been described as a safe and efficient treatment modality for suppurative OM in cats. Although recurrence can occur, surgical procedures, such as ventral bulla osteotomy, have been performed in some cases, and tympanostomy tube placement has been tried to reduce the recurrence rate and as the treatment of OM with effusion.

中耳炎（OM）既可以通过药物治疗也可以通过手术治疗。由于病因往往未知，在某些病例中，制定理想的治疗方案可能具有挑战性。鼓膜切开术随后进行中耳冲洗，以及使用糖皮质激素和抗生素（如果存在细菌感染）治疗，已被描述为安全有效的治疗化脓性中耳炎患猫的方法。虽然可能复发，但在某些病例中可进行外科手术，如腹侧鼓泡截骨术，为了降低复发率，并治疗OM伴积液已尝试进行鼓室造瘘放置导管。

 

Further studies are needed to evaluate the pathogenesis of OM in cats for a better treatment and control of the disease. Many questions remain unanswered. What is the importance of the subclinical MED? Do subclinical MED progress to symptomatic disease? Does subclinical OM need to be treated? Does viral infection of the upper respiratory tract contribute to the development of OM in cats? How can we manage cats with sinonasal disease to avoid chronicity and recurrence?

为了更好地治疗和控制该病，需要进一步研究猫OM的发病机制。许多问题仍未得到解答。亚临床医学的重要性是什么?亚临床医学会发展为有症状的疾病吗?亚临床OM是否需要治疗?上呼吸道的病毒感染是否会导致猫患中耳炎?我们如何治疗患有鼻窦炎的猫，以避免慢性和复发性?

 

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