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一位咽喉異常感症合併喉部謎樣X光顯影之老年女性

An Aged Female with Globus Pharyngis and an Enigmatic Laryngeal Radiographic Manifestation

Abstracts


咽喉異常感症是一般門診常見的疾病,症狀期在2週以上之患者中,60歲以上就佔了26.9%。年老患者的甲狀軟骨鈣化顯影相當常見,須先排除腫瘤性病變。65歲女性,因咽喉異常感症及吞嚥時喉部聲響1個月求診於作者。理學檢查(含軟式鼻咽喉內視鏡檢)發現兩側杓狀軟骨處及杓狀骨間區有輕度的腫脹,並無其他異常。在4週的抗胃酸逆流嘗試療法後,症狀仍未痊癒,頸部側面軟組織X光片意外發現喉部有一塊不規則的異常顯影。電腦斷層呈現甲狀軟骨右板的鈣化,食道鋇劑攝影無異常發現,軟式上消化道內視鏡檢顯示有胃竇處潰瘍及C級(Los Angeles分類)食道炎。在每日服用氫鉀幫浦拮抗劑3週後,咽喉異常感症就已經消失,雖然吞嚥時喉部聲響卻依舊,卻不再感到疑惑與焦慮。可見,本個案之咽喉異常感症實導因於胃食道逆流疾病,其吞嚥時喉部聲響應與杓狀軟骨的鈣化有關,以上這兩種症狀均與該甲狀軟骨之鈣化無關。

Parallel abstracts


Globus pharyngis is a common disease in the outpatient setting. Of patients with globus pharyngis for a duration of at least two weeks, 26.9% are those aged 60 years old and over. Calcification of thyroid cartilage is frequently seen in elderly patients and may occasionally result from neoplasm. A 65-year-old female visited the author after suffering globus pharynges and laryngeal click during swallowing for one month. Physical examinations and the flexible fiberoptic nasopharyngolaryngoscopy found no remarkable lesion. After four weeks of anti-reflux therapeutic trial, the symptoms continued to exist. The soft tissue neck X-ray was then performed and showed an irregular abnormal manifestation in the larynx, and computed tomography revealed calcification over the right lamina of the thyroid cartilage. Barium esophagogram did not show any abnormality while the flexible upper digestive endoscopy indicated antrum ulcers and grade C (Los Angeles classification) esophagitis. Daily administration of proton pump inhibitor for three weeks led to the disappearance of the globus symptom. Though laryngeal click during swallowing continued to take place, the patient no longer felt confused or anxious. It can therefore be inferred that the globus pharyngis was attributable to gastroesophageal reflux disease, and the swallowing laryngeal click was associated with calcification of arytenoid cartilages. Neither symptom seemed to be caused by calcification of the thyroid cartilage.

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