The Etiology of Globus Pharyngeus under Flexible Fiberoptic Nasopharyngoscopy and Laryngoscopy

咽喉異物感症於軟式鼻咽及喉內視鏡下之所見

陳建志(Jiann-Jy Chen)

《東港安泰醫護雜誌》 13卷2期 (2007/06) Pp. 79-90

https://doi.org/10.7078/TSMHMNJ.200706.0079

摘要

目的：咽喉異物感症是門診常見的主訴，病患描述在咽喉部位有異物哽住的感覺。在這回溯性的研究中，我們用軟式纖維鼻咽及喉內視鏡檢於這類的病患，並整合所有的報告。
方法：目標為2006年7月到2006年12月間，在桃園及新竹地區共1家區域及2家地區醫院的門診中，所有咽喉異物感的病患共計142名。在排除掉症狀期少於兩週者(n=27)及甲狀腺疾病者(n=5)後，尚餘110名（男62，女48），平均年齡52.1歲（23~85歲），症狀時間從2週到超過20年，66.4%是1年以內。以經鼻腔軟式纖維鼻咽及喉內視鏡檢後，把結果記錄下來。爾後所有的病患均接受適當的治療，期待症狀能夠在2個月內治癒，其中65.5%(n=72)接受了抗胃酸逆流治療。
結果：與咽喉異物感有關的發現可以分成4種：鼻涕倒流、喉部病灶、口咽病灶及喉咽部位之胃酸逆流。僅1種病灶者(66.4%)以咽喉部位之胃酸逆流及鼻涕倒流為多，合併2種病灶者(27.3%)以鼻涕倒流合併咽喉部位之胃酸逆流最多，合併3種病灶者(5.5%)以鼻涕倒流合併咽喉部位之胃酸逆流及口咽病灶最多；少數(0.1%)無任何發現。給予特定的治療後，75.5%(n=83)有達治療期望，15.5%(n=17)失去追蹤；但是，尚有9.1%(n=10)未達治療期望，其中4位尚在本科治療中，6位轉診至他科繼續治療，有1位病患最後診斷居然是食道癌。
結論：經由這種耳鼻喉科醫師專門的方法結果發現，咽喉部位的胃酸逆流和鼻涕倒流在咽喉異物感症似乎佔有重要的角色。利用軟式纖維鼻咽及喉內視鏡會比硬式喉鏡看到的還要多，特別是對於鼻涕倒流的診斷，但是，尚需要配合特定治療是否達到治療期望才能確立病因，否則，需要進一步的檢查，請記住，咽喉異物感症中潛藏著食道癌！

關鍵字

咽喉異物感症 ； 軟式纖維鼻咽及喉內視鏡

並列摘要

Background: Globus pharyngeus, described as a strange foreign-body sensation in pharyngo-larynx, is a common chief complaint at out-patient department. In this retrospective study, the reports of flexible fiberoptic nasopharyngoscopy and laryngoscopy were reviewed.
Methods: One hundred and forty-two patients were enrolled retrospectively at my clinics at 1 regional hospital and 2 local hospitals respectively located in Tao-Yuan county and in Hsin-Chu county during July to December, 2006. Twenty-seven patients with less-than-2-week symptoms and 5 patents with thyroid diseases were excluded. The age of the left 110 patients (62 male, and 48 female) ranged from 23 to 85 (mean, 52.1 years old). The duration of symptom was 2 weeks to even over 2 decades (≤1 years: 66.4 % of the patients). They were examined with flexible fiberoptic nasopharyngoscope and laryngoscope. The results were recorded. All the studying 110 patients were treated with specific therapies, and 65.5% (n=72) received anti-reflux therapy. It was expected that the globus pharyngeus could be cured within 2 months after being treated.
Result: The findings were classified into 4 categories, including postnasal drips (PNDs), laryngeal lesions (LLs), oropharyngeal lesions (OLs), and suspected laryngo-pharyngeal acid reflux (R/O LPR). R/O LPR and PNDs both predominated in the only-1-category group (66.4%); PNDs+R/O LPR, in the combined-2-category group (27.3%); PNDs+R/O LPR+OLs, in the combined-3-category group (5.5%). Negative finding was noted in 0.1%. After they were properly treated, 75.4 % (n=83) achieved the therapeutic expectancy and 15.5% (n=17) were lost followed-up. However, 9.1% (n=10) did not achieve the therapeutic expectancy; of them, 4 were followed up at my clinic, and 6 were transferred to other department; then surprisingly, one was diagnosed esophageal malignancy.
Conclusions: By this otorhinolaryngologic checking method, R/O LPR and PNDs appear important in globus pharyngeus. More aspects can be checked by flexible fiberoptic nasopharyngoscopy and laryngoscopy than by rigid laryngoscopy, especially for PNDs. The etiology is confirmed with flexible fiberoptic nasopharyngoscopy and laryngoscopy and the following specific therapeutic effect; otherwise, a further examination is recommended. Please keep in mind that esophageal malignancy hides in globus pharynges!

並列關鍵字

globus pharyngeus ； flexible fiberoptic nasopharyngoscope and laryngoscope