慢性回流性喉炎之診斷及治療

Diagnosis and Treatment in Chronic Reflux Laryngitis

熊明旺(Ming-Wang Hsiung) ； 王興萬(Hsing-Won Wang) ； 蘇文勇(Wen-Yang Su)

《中華民國耳鼻喉科醫學雜誌》 35卷6期 (2000/12) Pp. 389-393

https://doi.org/10.6286/2000.35.6.389

摘要

慢性回流性喉炎常見於正常健康人，其症狀有喉部不適、失聲、咳嗽、吞嚥痛、痰多、喉部異物感等，其造成之傷害最早期症狀為因纖毛性呼吸上皮損傷所產生
之分泌物滯留；而最嚴重者則為喉部上皮潰瘍合併肉芽組織，患者因黏液滯留於後喉部或黏液經過聲帶排出時，易有咳嗽或清喉嚨動作。慢動回流性喉炎第一常見症狀為清喉嚨動作，而第二第三常見症狀分別為喉部不適及聲音沙啞。慢性回流性喉炎之診斷主要是以可攜帶式24小時雙探頭胃酸監測儀行之。50%慢性回流性喉炎病人於接受抑制胃反流指示後均有不錯的效果；25%的病人除了接受抑制胃酸反流指示外，還需H2 抑制劑來治療慢性胃酸反流性喉炎；另25%病人尚需要較強的制酸劑，如；氫離子幫浦抑制劑以便改散慢胃酸反流性喉炎；而少部份病人則需要用到大量氫離子幫浦抑制劑來抑制劑來抑制胃酸分泌。抑制胃酸反流指示何氫離子幫浦抑制劑可以有效地治療聲帶潰瘍及肉芽組織。治療慢性回流性喉炎最常見的失敗原因有3；1) 僅施行抗生素2)未遵守醫師的抑制胃酸反流指示事項3)治療之時間不夠長。長期胃酸逆流是引起咽喉癌之危險因子之一，然而可藉由制酸劑及抑制胃酸反流指示予以控制。

關鍵字

慢性回流性喉炎 ； 可攜帶式24小時雙探頭胃酸監測試儀 ； 抑制胃酸反流指示 ； H2 抑制劑 ； 氫離子幫浦抑制劑

並列摘要

Chronic refluk laryngitis is commonly seen in otherwise healthy people. Symptoms of throat discomfort, voice changes, dysphagia, and secretion stasis can all occur in chronic reflux laryngitis. The earliest symptom to emerge with injury is a sensation of secretions resulting from damage to the ciliated respiratory epithelium. The most severe manifestation of chronic refluk laryngitis is actual ulceration with granulation of the laryngeal epithelium. Clumping of mucous in posterrior or strings of mucous across the vocal folds can provoke coughing and throat cleaing. The most common mani-festation of chronic reflux laryngitis is throat clearing. The second and third most common manifestations of chronic reflux laryngitis are a sore throat and a deterioration in voice quality with voice use. Ambulatory 24-hour double-probe pH monitoring is currently the standard for diagnosis of chronic reflux laryngitis. Approximately 50% of patients will have symptoms resolve if they follow the nocturnal antireflux precautions, Another 25% of patients who complain of chronic reflux laryngitis require a H2 blocker, in addition to following the nocturnal antireflux precautions. Approximately 25% of patients who fcomplan of chronic reflux laryngitis require prolonged treatment with a proton pump inhibitor. A few patients requier high-dosage proton pump inhibitors to suppress acid secretion. Treatment with antirflux precautions and proton pump inhibitors has been uniformly successful in the complete resolution of vocal process ulcers and granulomas. Common mistakes in the treatment of chronic reflux laryn- gitis are: 1) using antibiotics alone 2) not observing antireflux precautions 3) inadeqate length of treatment. A long history of reflux is an identified risk factors for carcinoma of the laryngophaynk, but it can be controlled with antireflux therapy and appropriate precautions.

並列關鍵字

Ctronic reflux laryngitis ； ambulatory 24-hour double-probe monitoring ； antireflux precau tion H2 blocker ； proton pump inhibitor