鼻炎的診斷

Diagnosis of Rhinitis

盧盈州(Ying-Chou Lu)

《台灣耳鼻喉頭頸外科雜誌》 46卷s_1期 (2011/07) Pp. 17-23

https://doi.org/10.6286/2011.46.s_1.17

摘要

鼻炎爲常見疾病，分爲過敏性、非過敏性。過敏性鼻炎較受重視，因此其臨床表徵、症狀較熟悉，診斷上需要再配合過敏檢查。習慣上，常以排除過敏性鼻炎來診斷非過敏性鼻炎，但其種類繁多、病因不一、且無專一特殊診斷工具，因此門診時雖經病史、問卷、理學檢查甚至過敏測試，仍無法得到正確診斷時，可行「診斷性治療」（口服第2代抗組織胺通常對非過敏性鼻炎無效，類固醇或抗組織胺鼻噴劑對過敏及非過敏大部份有效），依治療結果並追蹤分析其療效，再考慮修正診斷，此方式不影響治療結果、併發症、慢性病的產生及生活品質。鼻炎的診斷，以病史、症狀與理學檢查爲主，但其重疊性高，因此須配合過敏檢查或特殊檢查：如內視鏡、電腦斷層等，同時亦需與其他鼻病鑑別診斷。診斷時也要重視評估生活品質及共病症。病例的追蹤是診斷的重要項目之一，有些非過敏性鼻炎診斷會改變，共病症會增加，甚至過敏性鼻炎也可出現非過敏性鼻炎特質。

關鍵字

過敏性鼻炎 ； 非過敏性鼻炎 ； 診斷 ； 診斷性治療

並列摘要

Rhinitis is a prevalent disease classified as allergic or non-allergic rhinitis. Previous guidelines primarily focused on allergic rhinitis and eclipsed non-allergic rhinitis. Differentiated the typical symptoms of rhinitis into either allergic or non-allergic category is difficult. Non-allergic rhinitis usually is an excluded diagnosis of allergic rhinitis. Subtypes of non-allergic rhinitis are numerous, with different etiologies, no specified diagnostic instruments, so exact diagnosis in clinical practice sometimes frustrates the patients and clinicians. Therapeutic diagnosis (oral 2(superscript nd) generation antihistamine, nasal steroid or antihistamine, avoid triggers) just with simple history taking becomes an important box in algorithm of management of rhinitis. The symptoms and finding of physical examination of allergic and non-allergic rhinitis are overlapping. Complete history is still the most important for diagnosis of rhinitis, if necessary allergic test and specific examination (eg: nasal endoscopic examination, CT...) may be need. Assessment of quality of life, comorbidities of rhinitis and post-treatment follow up need to include in evaluation and diagnosis of rhinitis. Especially close follow up may find the evolution of diagnosis of non-allergic rhinitis to allergic rhinitis and change of comorbidities.

並列關鍵字

allergic rhinitis ； non-allergic rhinitis ； diagnosis ； therapeutic diagnosis